Fan Jingyao, Song Yiqing, Chen Yu, Hui Rutai, Zhang Weili
State Key Laboratory of Cardiovascular Diseases, Sino-German Laboratory for Molecular Medicine, FuWai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Int J Cardiol. 2013 Oct 12;168(5):4761-8. doi: 10.1016/j.ijcard.2013.07.230. Epub 2013 Aug 1.
Cardiovascular risk is inconsistent in the normal-weight, overweight, and obese individuals due to metabolic abnormality. We aimed to investigate combined effects of obesity and metabolic abnormality on the risk of cardiovascular disease and mortality.
The MEDLINE, EMBASE, Cochrane library, and references of relevant original articles prior to May 2013 were searched for prospective studies investigating cardiovascular risk and death associated with combined effects of obesity and metabolic syndrome or insulin resistance. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated using random-effects or fixed-effect models when appropriate.
Fourteen perspective studies with a total of 299,059 participants and 12,125 cases of incident CVD, 2130 cases of CVD death, and 7071 cases of all-cause death were included in the meta-analysis. Compared with healthy normal-weight individuals, metabolically healthy overweight (MHOW) and obese (MHOB) individuals showed increased risk for CVD events, which appeared much stronger during the long-term follow-up period of >15 years, with pooled RR of 1.47 (95% CI 1.37-1.58) in MHOW and 2.00 (95% CI 1.79-2.24) in MHOB. Normal-weight but metabolically abnormal individuals were at increased risk for CVD (pooled RR 1.81, 95% CI 1.56-2.10), CVD-related death (pooled RR 1.55, 95% CI 1.16-2.08), and all-cause death (pooled RR 1.27, 95% CI 1.10-1.47). Metabolically abnormal obese individuals were at the highest risk for CVD and mortality.
Individuals with metabolic abnormality, although at normal-weight, had an increased risk of CVD and mortality. Healthy overweight and obese persons had higher risk, which refuted the notion that metabolically healthy obese phenotype is a benign condition.
由于代谢异常，正常体重、超重和肥胖个体的心血管风险并不一致。我们旨在研究肥胖与代谢异常对心血管疾病风险和死亡率的综合影响。
检索MEDLINE、EMBASE、Cochrane图书馆以及2013年5月之前相关原始文章的参考文献，以查找调查肥胖与代谢综合征或胰岛素抵抗联合作用相关的心血管风险和死亡的前瞻性研究。在适当情况下，使用随机效应或固定效应模型计算合并相对风险（RR）和95%置信区间（CI）。
荟萃分析纳入了14项前瞻性研究，共有299,059名参与者，发生12,125例心血管疾病事件、2130例心血管疾病死亡和7071例全因死亡。与健康的正常体重个体相比，代谢健康的超重（MHOW）和肥胖（MHOB）个体发生心血管疾病事件的风险增加，在超过15年的长期随访期间这种风险似乎更强，MHOW的合并RR为1.47（95%CI 1.37 - 1.58），MHOB为2.00（95%CI 1.79 - 2.24）。正常体重但代谢异常的个体患心血管疾病的风险增加（合并RR 1.81，95%CI 1.56 - 2.10）、心血管疾病相关死亡风险增加（合并RR 1.55，95%CI 1.16 - 2.08）以及全因死亡风险增加（合并RR 1.27，95%CI 1.10 - 1.47）。代谢异常的肥胖个体患心血管疾病和死亡的风险最高。
代谢异常的个体尽管体重正常，但患心血管疾病和死亡的风险增加。健康的超重和肥胖者风险更高，这驳斥了代谢健康的肥胖表型是良性状况的观点。
