1 Cardiovascular Sciences Research Centre, St George's University of London, UK.
2 Cardiovascular Pathology Department, St George's University of London, UK.
Eur J Prev Cardiol. 2018 Mar;25(4):395-401. doi: 10.1177/2047487317751291. Epub 2018 Jan 10.
Aims Obesity is an increasing public health problem and a risk factor for cardiovascular diseases. The aim of the study was to determine the main features and aetiologies in a large cohort of sudden cardiac deaths that occurred in obese subjects. Methods Between 1994 and 2014, 3684 consecutive cases of unexpected sudden cardiac death were referred to our cardiac pathology centre. This study was confined to young individuals (age ≤ 35 years) for whom information about body mass index was available and consisted of 1033 cases. Results Two-hundred and twelve individuals (20%) were obese. In obese sudden cardiac death victims the main post-mortem findings were: normal heart (sudden arrhythmic death syndrome) ( n = 108; 50%), unexplained left ventricular hypertrophy ( n = 25; 12%) and critical coronary artery disease ( n = 25; 12%). Less common were hypertrophic cardiomyopathy ( n = 4; 2%) and arrhythmogenic right ventricular cardiomyopathy ( n = 4;2%). When compared with non-obese sudden cardiac death victims, sudden arrhythmic death syndrome was less common (50% vs. 60%, P < 0.01), whereas left ventricular hypertrophy and critical coronary artery disease were more frequent (12% vs. 2%, P < 0.001 and 12% vs. 3%, P < 0.001, respectively). The prevalence of critical and non-critical coronary artery disease was significantly higher in obese individuals (23% vs. 10% in non-obese individuals, P < 0.001). Conclusions Various conditions underlie sudden cardiac death in obesity, with a prevalence of sudden arrhythmic death syndrome, left ventricular hypertrophy and coronary artery disease. The degree of left ventricular hypertrophy measured by heart weight is excessive even after correction for body size. Almost one in four young obese sudden death patients show some degree of coronary artery disease, underscoring the need for primary prevention in this particular subgroup.
目的 肥胖是一个日益严重的公共卫生问题，也是心血管疾病的一个危险因素。本研究的目的是确定大量肥胖患者发生的心脏性猝死的主要特征和病因。
方法 1994 年至 2014 年间，我们的心脏病理中心共接收了 3684 例意外心脏性猝死的连续病例。本研究仅限于有体重指数信息的年轻个体（年龄≤35 岁），共 1033 例。
结果 212 名个体（20%）肥胖。在肥胖的心脏性猝死患者中，主要的死后发现包括：正常心脏（心律失常性死亡综合征）（n=108；50%）、原因不明的左心室肥厚（n=25；12%）和严重的冠状动脉疾病（n=25；12%）。较少见的有肥厚型心肌病（n=4；2%）和致心律失常性右室心肌病（n=4；2%）。与非肥胖心脏性猝死患者相比，心律失常性死亡综合征更少见（50%比 60%，P<0.01），而左心室肥厚和严重的冠状动脉疾病更为常见（12%比 2%，P<0.001 和 12%比 3%，P<0.001）。肥胖个体中严重和非严重冠状动脉疾病的患病率明显更高（肥胖个体中为 23%，非肥胖个体中为 10%，P<0.001）。
结论 肥胖患者心脏性猝死的原因各不相同，以心律失常性死亡综合征、左心室肥厚和冠状动脉疾病为主要原因。即使根据体重进行校正，心脏重量测量的左心室肥厚程度也过高。近四分之一的年轻肥胖心脏性猝死患者存在一定程度的冠状动脉疾病，突出了这一特定亚组需要进行一级预防。
