Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, Louisiana; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana.
Department of Human Performance and Sport Sciences, Winston-Salem State University, Winston-Salem, North Carolina.
J Am Coll Cardiol. 2014 Apr 15;63(14):1345-54. doi: 10.1016/j.jacc.2014.01.022. Epub 2014 Feb 12.
Obesity has been increasing in epidemic proportions, with a disproportionately higher increase in morbid or class III obesity, and obesity adversely affects cardiovascular (CV) hemodynamics, structure, and function, as well as increases the prevalence of most CV diseases. Progressive declines in physical activity over 5 decades have occurred and have primarily caused the obesity epidemic. Despite the potential adverse impact of overweight and obesity, recent epidemiological data have demonstrated an association of mild obesity and, particularly, overweight on improved survival. We review in detail the obesity paradox in CV diseases where overweight and at least mildly obese patients with most CV diseases seem to have a better prognosis than do their leaner counterparts. The implications of cardiorespiratory fitness with prognosis are discussed, along with the joint impact of fitness and adiposity on the obesity paradox. Finally, in light of the obesity paradox, the potential value of purposeful weight loss and increased physical activity to affect levels of fitness is reviewed.
肥胖症呈流行趋势，病态肥胖或 III 类肥胖的增长尤为显著，肥胖会对心血管（CV）血液动力学、结构和功能产生不利影响，并增加大多数 CV 疾病的患病率。50 年来，体力活动呈持续下降趋势，这主要导致了肥胖症的流行。尽管超重和肥胖可能带来潜在的不利影响，但最近的流行病学数据表明，轻度肥胖和超重，尤其是与大多数 CV 疾病相关的超重，与改善的生存率相关。我们详细回顾了 CV 疾病中的肥胖悖论，即患有大多数 CV 疾病的超重和至少轻度肥胖患者的预后似乎优于体型较瘦的患者。我们还讨论了心肺适能与预后的关系，以及适能和肥胖对肥胖悖论的联合影响。最后，鉴于肥胖悖论，我们回顾了有目的的体重减轻和增加体力活动对影响健康水平的潜在价值。
