Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio 44195, USA.
Curr Opin Cardiol. 2013 Sep;28(5):540-6. doi: 10.1097/HCO.0b013e3283642a33.
Obesity is an independent risk factor for cardiovascular disease (CVD) and promotes CVD risk factors. Bariatric surgery has gained much favor because it ameliorates CVD. This review examines the current evidence for the mechanism behind this, which is currently thought to occur in part by reduction of adiposopathy, or dysfunctional adipose tissue, through modulation of adipokine secretion.
Increased visceral fat in obesity leads to adiposopathy, due to the chronic inflammation present in this tissue. Bariatric surgery causes weight loss as well as reduction in insulin resistance, hypertension, dyslipidemia, cardiac hypertrophy, and mortality. It also causes changes in the adipokines adiponectin, leptin, and C-reactive protein, but not in tumor necrosis factor-α. These changes contribute to improved CVD risk, possibly through decrease of chronic inflammation.
The modulations in adipokine secretion that occur after bariatric surgery are involved with reduction in CVD risk factors, CVD, and CV mortality. On the basis of the known anti-inflammatory effects of adiponectin and the pro-inflammatory effects of leptin and CRP, reduction in chronic inflammation associated with less visceral fat after surgery may contribute to the reduction in CVD. This may promote improvement of endothelial dysfunction and insulin resistance. Further work is necessary to explore these relationships.
肥胖是心血管疾病（CVD）的独立危险因素，并促进 CVD 风险因素的发展。减重手术因其改善 CVD 而备受青睐。本综述探讨了目前对此机制的证据，目前认为这种机制部分是通过调节脂联素等脂肪因子的分泌，减轻脂肪病或功能失调的脂肪组织来实现的。
肥胖导致内脏脂肪增加，进而导致脂肪病，这是由于该组织存在慢性炎症。减重手术不仅可以减轻体重，还可以降低胰岛素抵抗、高血压、血脂异常、心肌肥厚和死亡率。它还会引起脂联素、瘦素和 C 反应蛋白等脂肪因子的变化，但不会引起肿瘤坏死因子-α的变化。这些变化有助于降低 CVD 风险，可能是通过减少慢性炎症。
减重手术后脂肪因子分泌的调节与 CVD 风险因素、CVD 和 CV 死亡率的降低有关。基于脂联素的已知抗炎作用以及瘦素和 CRP 的促炎作用，手术后与内脏脂肪减少相关的慢性炎症减少可能有助于降低 CVD。这可能有助于改善内皮功能障碍和胰岛素抵抗。需要进一步研究来探索这些关系。
