First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
First Department of Propaedeutic Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
Metabolism. 2019 Mar;92:98-107. doi: 10.1016/j.metabol.2018.10.011. Epub 2018 Nov 3.
A wealth of clinical and epidemiological evidence has linked obesity to a broad spectrum of cardiovascular diseases (CVD) including coronary heart disease, heart failure, hypertension, stroke, atrial fibrillation and sudden cardiac death. Obesity can increase CVD morbidity and mortality directly and indirectly. Direct effects are mediated by obesity-induced structural and functional adaptations of the cardiovascular system to accommodate excess body weight, as well as by adipokine effects on inflammation and vascular homeostasis. Indirect effects are mediated by co-existing CVD risk factors such as insulin resistance, hyperglycemia, hypertension and dyslipidemia. Adipose tissue (AT) quality and functionality are more relevant aspects for cardiometabolic risk than its total amount. The consequences of maladaptive AT expansion in obesity are local and systemic: the local include inflammation, hypoxia, dysregulated adipokine secretion and impaired mitochondrial function; the systemic comprise insulin resistance, abnormal glucose/lipid metabolism, hypertension, a pro-inflammatory and pro-thrombotic state and endothelial dysfunction, all of which provide linking mechanisms for the association between obesity and CVD. The present narrative review summarizes the major pathophysiological links between obesity and CVD (traditional and novel concepts), analyses the heterogeneity of obesity-related cardiometabolic consequences, and provides an overview of the cardiovascular impact of weight loss interventions.
大量的临床和流行病学证据表明，肥胖与广泛的心血管疾病（CVD）有关，包括冠心病、心力衰竭、高血压、中风、心房颤动和心源性猝死。肥胖可以直接和间接增加 CVD 的发病率和死亡率。直接影响是通过肥胖引起的心血管系统的结构和功能适应性来适应多余的体重，以及脂肪因子对炎症和血管稳态的影响来介导的。间接影响是通过共存的 CVD 风险因素介导的，如胰岛素抵抗、高血糖、高血压和血脂异常。脂肪组织（AT）的质量和功能比其总量与心脏代谢风险更相关。肥胖中适应性 AT 扩张的后果是局部和全身的：局部包括炎症、缺氧、失调的脂肪因子分泌和受损的线粒体功能；全身包括胰岛素抵抗、异常的葡萄糖/脂质代谢、高血压、促炎和促血栓形成状态以及内皮功能障碍，所有这些都为肥胖与 CVD 之间的关联提供了联系机制。本综述总结了肥胖与 CVD（传统和新概念）之间的主要病理生理联系，分析了肥胖相关心脏代谢后果的异质性，并概述了体重减轻干预对心血管的影响。
