Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan.
Ann Med. 2012 May;44(3):233-41. doi: 10.3109/07853890.2011.564202. Epub 2011 May 25.
Atherosclerosis, the underlying cause of atherosclerotic cardiovascular disease (ACVD), develops due not only to a single cardiovascular risk factor but to a variety of complex factors. The concept of the multiple cardiometabolic risk factor clustering syndrome has been proposed as a highly atherogenic state, independent of hypercholesterolemia and smoking. Body fat distribution, especially visceral fat accumulation, is a major correlate of a cluster of diabetogenic, atherogenic, prothrombotic, and proinflammatory metabolic abnormalities referred to as the metabolic syndrome, with dysfunctional adipocytes and dysregulated production of adipocytokines (hypoadiponectinemia). Medical research has focused on visceral adiposity as an important component of the syndrome in Japanese subjects with a mild degree of adiposity compared with Western subjects. For the prevention of ACVD at least in Japan, it might be practical to stratify subjects with multiple risk factors for atherosclerotic cardiovascular disease based on visceral fat accumulation. Visceral fat reduction through health promotion programs using risk factor-oriented approaches may be effective in reducing ACVD events, as well as producing improvement in risks and hypoadiponectinemia. This review article discusses visceral adiposity as a key player in the syndrome. Visceral fat reduction with life-style modification is a potentially useful strategy in the prevention of ACVD in patients with the metabolic syndrome.
动脉粥样硬化是动脉粥样硬化性心血管疾病（ACVD）的根本原因，其发生不仅与单一心血管危险因素有关，还与多种复杂因素有关。多种心血管代谢危险因素聚集综合征的概念被提出，作为一种高度致动脉粥样硬化的状态，独立于高胆固醇血症和吸烟。体脂分布，尤其是内脏脂肪堆积，是与糖尿病、动脉粥样硬化、血栓形成和炎症代谢异常等多种代谢异常相关的一个重要指标，这些异常被称为代谢综合征，伴有功能失调的脂肪细胞和失调的脂肪细胞因子（低 adiponectinemia）产生。医学研究集中在内脏肥胖作为与西方人群相比，日本人群中肥胖程度较轻的综合征的一个重要组成部分。为了预防 ACVD，至少在日本，根据内脏脂肪堆积情况，对具有动脉粥样硬化性心血管疾病多种危险因素的患者进行分层可能是实用的。通过使用以危险因素为导向的方法进行健康促进计划来减少内脏脂肪，可能会有效降低 ACVD 事件的发生，同时改善风险和低 adiponectinemia。本文讨论了内脏脂肪作为该综合征的关键因素。通过生活方式改变来减少内脏脂肪是预防代谢综合征患者 ACVD 的一种潜在有用的策略。
