Asghar O, Alam U, Hayat S A, Aghamohammadzadeh R, Heagerty A M, Malik R A
Division of Cardiovascular Sciences, The University of Manchester, UK.
Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK.
J Atr Fibrillation. 2013 Aug 31;6(2):869. doi: 10.4022/jafib.869. eCollection 2013 Aug-Sep.
Body mass index (BMI) is a powerful predictor of death, type 2 diabetes (T2DM) and cardiovascular (CV) morbidity and mortality. Over the last few decades, we have witnessed a global rise in adult obesity of epidemic proportions. Similarly, there has been a parallel increase in the incidence of atrial fibrillation (AF), itself a significant cause of cardiovascular morbidity and mortality. This may be partly attributable to advances in the treatment of coronary heart disease (CHD) and heart failure (HF) improving life expectancy, however, epidemiological studies have demonstrated an independent association between obesity, diabetes and AF, suggesting possible common pathophysiological mechanisms and risk factors. Indeed, cardiac remodeling, haemodynamic alterations, autonomic dysfunction, and diastolic dysfunction have been reported in obese and diabetic cohorts. Moreover, diabetic cardiomyopathy is characterized by an adverse structural and functional cardiac phenotype, which may predispose to the development of AF. In this review, we discuss the pathophysiological and mechanistic relationships between obesity, diabetes and AF, and some of the challenges posed in the management of this high-risk group of individuals.
体重指数（BMI）是死亡、2型糖尿病（T2DM）以及心血管（CV）疾病发病率和死亡率的有力预测指标。在过去几十年间，我们目睹了全球范围内成人肥胖呈流行态势增长。同样，心房颤动（AF）的发病率也相应增加，而心房颤动本身就是心血管疾病发病率和死亡率的一个重要原因。这可能部分归因于冠心病（CHD）和心力衰竭（HF）治疗方面的进展提高了预期寿命，然而，流行病学研究已证实肥胖、糖尿病与心房颤动之间存在独立关联，提示可能存在共同的病理生理机制和危险因素。确实，在肥胖和糖尿病患者队列中已报道存在心脏重塑、血流动力学改变、自主神经功能障碍以及舒张功能障碍。此外，糖尿病性心肌病的特征是心脏结构和功能出现不良表型，这可能易引发心房颤动。在本综述中，我们讨论肥胖、糖尿病与心房颤动之间的病理生理和机制关系，以及管理这一高危人群所面临的一些挑战。
