Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai 200032, China; Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA.
Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai 200032, China; Center for Cardiovascular Research and Alternative Medicine, University of Wyoming College of Health Sciences, Laramie, WY 82071, USA.
Prog Cardiovasc Dis. 2018 Jul-Aug;61(2):182-189. doi: 10.1016/j.pcad.2018.07.011. Epub 2018 Jul 7.
Recent advances in medical technology and health care have greatly improved the management for chronic diseases and prolonged human lifespan. Unfortunately, increased lifespan and the aging population impose a major challenge on the ever-rising prevalence of chronic diseases, in particular cardiometabolic stress associated with the pandemic obesity in our modern society. Although overweight and obesity are associated with incident cardiovascular diseases (CVD), including heart failure (HF), it paradoxically leads to a more favorable prognosis in patients with chronic HF, a phenomenon commonly defined as "obesity paradox". Numerous population-based and clinical studies have suggested possible explanations such as better metabolic reserve, smoking and disease-associated weight loss for obesity paradox. Recent evidence noticed a shift in obesity paradox with aging. While some studies have reported a more pronounced "obesity paradox" in the older patients, others have seen diminished cardiac benefits with overweight and obesity in the elderly patients with CVD. These findings suggested that a complex relationship among aging, metabolism, and HF severity/chronicity, which may explain the shift in obesity paradox in the elderly. Aging negatively affects body metabolism and cardiac function although its precise impact on obesity paradox remains elusive. To develop new strategies for cardiovascular health in the elderly, it is imperative to understand the precise role for aging on obesity-related CVD.
近年来，医学技术和医疗保健的进步极大地改善了慢性病的管理，延长了人类的寿命。不幸的是，寿命的延长和人口老龄化给不断上升的慢性病患病率带来了重大挑战，特别是与我们现代社会大流行肥胖相关的心脏代谢压力。尽管超重和肥胖与心血管疾病（CVD）包括心力衰竭（HF）的发生有关，但它在慢性 HF 患者中却带来了更有利的预后，这种现象通常被定义为“肥胖悖论”。大量基于人群的和临床研究提出了可能的解释，例如更好的代谢储备、吸烟和与疾病相关的体重减轻，这些都有助于解释肥胖悖论。最近的证据注意到肥胖悖论随年龄的变化而发生转变。虽然一些研究报告说，年龄较大的患者中“肥胖悖论”更为明显，但其他研究发现，超重和肥胖对患有 CVD 的老年患者的心脏益处减少。这些发现表明，衰老、代谢和 HF 严重程度/慢性之间的复杂关系可能解释了老年患者肥胖悖论的转变。衰老会对身体代谢和心脏功能产生负面影响，尽管其对肥胖悖论的确切影响仍难以捉摸。为了制定老年人心血管健康的新策略，了解衰老对肥胖相关 CVD 的确切作用至关重要。
