Brant Luisa C C, Wang Na, Ojeda Francisco M, LaValley Michael, Barreto Sandhi M, Benjamin Emelia J, Mitchell Gary F, Vasan Ramachandran S, Palmisano Joseph N, Münzel Thomas, Blankenberg Stefan, Wild Philipp S, Zeller Tanja, Ribeiro Antonio L P, Schnabel Renate B, Hamburg Naomi M
Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil), Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Data Coordinating Center, Boston University School of Public Health, Boston, MA.
J Am Heart Assoc. 2017 Mar 8;6(3):e004199. doi: 10.1161/JAHA.116.004199.
Microvascular dysfunction is a marker of early vascular disease that predicts cardiovascular events. Whether metabolically healthy obese individuals have impaired microvascular function remains unclear. The aim of this study was to evaluate the relation of obesity phenotypes stratified by metabolic status to microvascular function.
We meta-analyzed aggregate data from 3 large cohorts (Brazilian Longitudinal Study of Adult Health, the Framingham Heart Study, and the Gutenberg Heart Study; n=16 830 participants, age range 19-90, 51.3% men). Regression slopes between cardiovascular risk factors and microvascular function, measured by peripheral arterial tonometry (PAT), were calculated. Individuals were classified as normal-weight, overweight, or obese by body mass index (BMI) and stratified by healthy or unhealthy metabolic status based on metabolic syndrome using the ATP-III criteria. Male sex, BMI, and metabolic risk factors were associated with higher baseline pulse amplitude and lower PAT ratio. There was stepwise impairment of vascular measures from normal weight to obesity in both metabolic status strata. Metabolically healthy obese individuals had more impaired vascular function than metabolically healthy normal-weight individuals (baseline pulse amplitude 6.12±0.02 versus 5.61±0.01; PAT ratio 0.58±0.01 versus 0.76±0.01, all <0.0001). Metabolically unhealthy obese individuals had more impaired vascular function than metabolically healthy obese individuals (baseline pulse amplitude 6.28±0.01 versus 6.12±0.02; PAT ratio 0.49±0.01 versus 0.58±0.01, all <0.0001).
Metabolically healthy obese individuals have impaired microvascular function, though the degree of impairment is less marked than in metabolically unhealthy obese individuals. Our findings suggest that obesity is detrimental to vascular health irrespective of metabolic status.
微血管功能障碍是早期血管疾病的一个标志物，可预测心血管事件。代谢健康的肥胖个体的微血管功能是否受损仍不清楚。本研究的目的是评估按代谢状态分层的肥胖表型与微血管功能之间的关系。
我们对来自3个大型队列（巴西成人健康纵向研究、弗雷明汉心脏研究和古登堡心脏研究；n = 16830名参与者，年龄范围19 - 90岁，51.3%为男性）的汇总数据进行了荟萃分析。计算了心血管危险因素与通过外周动脉张力测定法（PAT）测量的微血管功能之间的回归斜率。个体根据体重指数（BMI）分为正常体重、超重或肥胖，并根据ATP - III标准基于代谢综合征按健康或不健康的代谢状态进行分层。男性、BMI和代谢危险因素与较高的基线脉搏振幅和较低的PAT比值相关。在两个代谢状态分层中，从正常体重到肥胖，血管测量指标存在逐步损害。代谢健康的肥胖个体比代谢健康的正常体重个体有更受损的血管功能（基线脉搏振幅6.12±0.02对5.61±0.01；PAT比值0.58±0.01对0.76±0.01，均<0.0001）。代谢不健康的肥胖个体比代谢健康的肥胖个体有更受损的血管功能（基线脉搏振幅6.28±0.01对6.12±0.02；PAT比值0.49±0.01对0.58±0.01，均<0.0001）。
代谢健康的肥胖个体微血管功能受损，尽管受损程度不如代谢不健康的肥胖个体明显。我们的研究结果表明，无论代谢状态如何，肥胖对血管健康都是有害的。
