Fontes-Carvalho Ricardo, Gonçalves Alexandra, Severo Milton, Lourenço Patrícia, Rocha Gonçalves Francisco, Bettencourt Paulo, Leite-Moreira Adelino, Azevedo Ana
EPIUnit - Institute of Public Health, University of Porto (ISPUP), Porto, Portugal; Cardiology Department, Gaia Hospital Center, Gaia, Portugal; Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Int J Cardiol. 2015 Jul 15;191:64-70. doi: 10.1016/j.ijcard.2015.04.250. Epub 2015 May 1.
Obesity has been associated with subclinical diastolic dysfunction and increased risk of heart failure. Our aims were to evaluate the age- and sex-specific role of total and abdominal adiposity on diastolic function and to assess the direct and indirect pathophysiological mechanisms involved in this association.
Within a population-based study (EPIPorto), a total of 1063 individuals aged ≥ 45 years (62% female; 62.4 ± 10.6 years) were evaluated using echocardiography, anthropometrics, electrical bioimpedance and blood tests. Diastolic function was assessed with using EAE/ASE consensus criteria. Worse diastolic function grades were associated with increased BMI, fat mass % and waist-to-height ratio (p for trend<0.001). The inverse association between adiposity and diastolic function was stronger in men and in the younger population. In multivariate analysis, waist-to-height ratio (per cm/cm) was associated with reduced E' velocity (adjusted β: -14.4; 95% CI: -21.1 to -7.6; p<0.001) and increased E/E' ratio (adjusted β: 9.7, 95% CI: 5.4-10.0; p<0.001), among men<65 years. Both direct and indirect mechanisms were involved in the E' velocity decrease by waist-to-height ratio in participants<65 years. The effect was mainly direct in men (81.3%), while it was mostly indirect in women, through systolic blood pressure (50.8%) and inflammation (15.1%).
Adiposity, especially abdominal, was associated with worse diastolic function. This association was more important in men and in the younger population. The causal mechanisms involved were sex-specific, with mostly direct effects among men and blood-pressure-mediated among women.
肥胖与亚临床舒张功能障碍及心力衰竭风险增加有关。我们的目的是评估总体和腹部肥胖对舒张功能的年龄和性别特异性作用，并评估这种关联中涉及的直接和间接病理生理机制。
在一项基于人群的研究（EPIPorto）中，共对1063名年龄≥45岁的个体（62%为女性；62.4±10.6岁）进行了超声心动图、人体测量学、生物电阻抗和血液检查评估。使用EAE/ASE共识标准评估舒张功能。较差的舒张功能分级与体重指数、体脂百分比和腰高比增加相关（趋势p<0.001）。肥胖与舒张功能之间的负相关在男性和年轻人群中更强。在多变量分析中，腰高比（每厘米/厘米）与E'速度降低相关（调整β：-14.4；95%置信区间：-21.1至-7.6；p<0.001），在65岁以下男性中E/E'比值增加（调整β：9.7，95%置信区间：5.4-10.0；p<0.001）。在65岁以下参与者中，腰高比降低E'速度涉及直接和间接机制。在男性中，这种影响主要是直接的（81.3%），而在女性中，主要是通过收缩压（50.8%）和炎症（15.1%）间接产生的。
肥胖，尤其是腹部肥胖，与较差的舒张功能相关。这种关联在男性和年轻人群中更为重要。所涉及的因果机制具有性别特异性，男性中大多为直接影响，女性中则为血压介导。
