First Department of Cardiology, Athens University Medical School, Hippokration Hospital, Athens, Greece.
J Am Coll Cardiol. 2011 Sep 20;58(13):1343-50. doi: 10.1016/j.jacc.2011.04.047.
The purpose of this study was to assess whether the metabolically healthy obese phenotype is associated with lower heart failure (HF) risk compared with normal-weight individuals with metabolic syndrome (MetS).
Obesity and MetS often coexist and are associated with increased HF risk. It is controversial whether obese individuals with normal insulin sensitivity have decreased HF risk.
A total of 550 individuals without diabetes or baseline macrovascular complications were studied during a median follow-up of 6 years. Participants were classified by presence (n = 271) or absence (n = 279) of MetS and by body mass index (body mass index: <25 kg/m(2) = normal weight, n = 177; 25 to 29.9 kg/m(2) = overweight, n = 234; ≥ 30 kg/m(2) = obese, n = 139). MetS was diagnosed with the National Cholesterol Education Program Adult Treatment Panel III criteria. Left ventricular functional capacity, myocardial structure, and performance were assessed echocardiographically.
Body mass index was not associated with increased HF risk. The presence of MetS conferred a 2.5-fold higher HF risk (hazard ratio [HR]: 2.5, 95% confidence interval [CI]: 1.68 to 3.40). Overweight and obese individuals without MetS had the lowest 6-year HF risk (HR: 1.12, 95% CI: 0.35 to 1.33 [corrected] and HR: 0.41, 95% CI: 0.10 to 1.31, respectively) compared with normal-weight individuals with MetS (HR: 2.33, 95% CI: 1.25 to 4.36, p < 0.001). From the individual components of MetS, impaired fasting glucose (HR: 1.09, 95% CI: 1.06 to 1.10), high BP (HR: 2.36, 95% CI: 1.03 to 5.43), low high-density lipoprotein cholesterol (HR: 1.88, 95% CI: 1.29 to -2.77), and central obesity (HR: 2.22, 95% CI: 1.02 to 1.05) were all associated with increased HF risk. Factors commonly associated with MetS such as insulin resistance and inflammation (high-sensitivity C-reactive protein and microalbuminuria) were also independently associated with HF incidence.
In contrast to normal weight insulin-resistant individuals, metabolically healthy obese individuals show decreased HF risk in a 6-year follow-up study.
本研究旨在评估与代谢综合征（MetS）正常体重个体相比，代谢健康肥胖表型是否与较低的心力衰竭（HF）风险相关。
肥胖和 MetS 常同时存在，并与 HF 风险增加相关。肥胖个体胰岛素敏感性正常是否降低 HF 风险存在争议。
在中位随访 6 年期间，对 550 名无糖尿病或基线大血管并发症的个体进行了研究。根据是否存在 MetS（n=271）或不存在 MetS（n=279）以及体重指数（BMI：<25kg/m2=正常体重，n=177；25 至 29.9kg/m2=超重，n=234；≥30kg/m2=肥胖，n=139）对参与者进行分类。MetS 采用美国国家胆固醇教育计划成人治疗小组 III 标准诊断。使用超声心动图评估左心室功能容量、心肌结构和功能。
BMI 与 HF 风险增加无关。MetS 的存在使 HF 风险增加 2.5 倍（风险比[HR]：2.5，95%置信区间[CI]：1.68 至 3.40）。无 MetS 的超重和肥胖个体 6 年 HF 风险最低（HR：1.12，95%CI：0.35 至 1.33[校正]和 HR：0.41，95%CI：0.10 至 1.31，分别）与 MetS 正常体重个体（HR：2.33，95%CI：1.25 至 4.36，p<0.001）。从 MetS 的各个组成部分来看，空腹血糖受损（HR：1.09，95%CI：1.06 至 1.10）、高血压（HR：2.36，95%CI：1.03 至 5.43）、低高密度脂蛋白胆固醇（HR：1.88，95%CI：1.29 至-2.77）和中心性肥胖（HR：2.22，95%CI：1.02 至 1.05）均与 HF 风险增加相关。与 MetS 相关的常见因素，如胰岛素抵抗和炎症（高敏 C 反应蛋白和微量白蛋白尿）也与 HF 发生率独立相关。
与正常体重胰岛素抵抗个体相比，代谢健康肥胖个体在 6 年随访中显示 HF 风险降低。
