Vidal-Perez Rafael, Franco-Gutiérrez Raúl, Pérez-Pérez Alberto J, Franco-Gutiérrez Virginia, Gascón-Vázquez Alberto, López-López Andrea, Testa-Fernández Ana María, González-Juanatey Carlos
Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo 27003, Spain.
Department of Otolaryngology, Hospital Carmen y Severo Ochoa, Cangas del Narcea 33800, Spain.
World J Cardiol. 2019 Jan 26;11(1):24-37. doi: 10.4330/wjc.v11.i1.24.
Obesity is a major health problem due to its high prevalence. The relationship between obesity and cardiovascular disease is unclear. Some studies agree that certain conditions associated with obesity, such as physical inactivity or cardiovascular risk factors, are responsible for cardiovascular risk excess among obese people. Carotid intima-media thickness and carotid plaques (CP) have been associated with cardiovascular adverse events in healthy populations, and recent data suggest a higher prevalence of subclinical carotid atherosclerosis in obese and metabolically unhealthy patients. However, there are no studies correlating subclinical atherosclerosis and adverse events (AE) in obese subjects.
To determine the association between carotid disease and AE in obese patients with negative exercise echocardiography (EE).
From January 1, 2006 to December 31, 2010, 2000 consecutive patients with a suspicion of coronary artery disease were submitted for EE and carotid ultrasonography. Exclusion criteria included previous vascular disease, left ventricular ejection fraction < 50%, positive EE, significant valvular heart disease and inferior to submaximal EE. An AE was defined as all-cause mortality, myocardial infarction and cerebrovascular accident. Subclinical atherosclerosis was defined as CP presence according to Manheim and the American Society of Echocardiography Consensus.
Of the 652 patients who fulfilled the inclusion criteria, 226 (34.7%) had body mass indexes ≥ 30 kg/m, and 76 of them (33.6%) had CP. During a mean follow-up time of 8.2 (2.1) years, 27 AE were found (11.9%). Mean event-free survival at 1, 5 and 10 years was 99.1% (0.6), 95.1% (1.4) and 86.5% (2.7), respectively. In univariate analysis, CP predicted AE [hazard ratio (HR) 2.52, 95% confidence interval (CI) 1.17-5.46; = 0.019]. In multivariable analysis, the presence of CP remained a predictor of AE (HR 2.26, 95%CI 1.04-4.95, = 0.041). Other predictors identified were glomerular filtration rate (HR 0.98, 95%CI 0.96-0.99; = 0.023), peak metabolic equivalents (HR 0.83, 95%CI 0.70-0.99, = 0.034) and moderate mitral regurgitation (HR 5.02, 95%CI 1.42-17.75, = 0.012).
Subclinical atherosclerosis defined by CP predicts AE in obese patients with negative EE. These patients could benefit from aggressive prevention measures.
肥胖因其高患病率成为一个主要的健康问题。肥胖与心血管疾病之间的关系尚不清楚。一些研究认为，与肥胖相关的某些状况，如身体活动不足或心血管危险因素，是肥胖人群心血管风险增加的原因。在健康人群中，颈动脉内膜中层厚度和颈动脉斑块（CP）与心血管不良事件相关，最近的数据表明，肥胖和代谢不健康的患者中亚临床颈动脉粥样硬化的患病率更高。然而，尚无研究将肥胖受试者的亚临床动脉粥样硬化与不良事件（AE）相关联。
确定运动负荷超声心动图（EE）阴性的肥胖患者中颈动脉疾病与AE之间的关联。
从2006年1月1日至2010年12月31日，连续2000例疑似冠心病患者接受了EE和颈动脉超声检查。排除标准包括既往血管疾病、左心室射血分数<50%、EE阳性、严重瓣膜性心脏病以及低于次极量EE。AE定义为全因死亡率、心肌梗死和脑血管意外。根据曼海姆标准和美国超声心动图学会共识，亚临床动脉粥样硬化定义为存在CP。
在符合纳入标准的652例患者中，226例（34.7%）体重指数≥30kg/m²，其中76例（33.6%）有CP。在平均8.2（2.1）年的随访期内，发现27例AE（11.9%）。1年、5年和10年的平均无事件生存率分别为99.1%（0.6）、95.1%（1.4）和86.5%（2.7）。单因素分析中，CP可预测AE [风险比（HR）2.52，95%置信区间（CI）1.17 - 5.46；P = 0.019]。多变量分析中，CP的存在仍是AE的预测因素（HR 2.26，95%CI 1.04 - 4.95，P = 0.041）。其他确定的预测因素为肾小球滤过率（HR 0.98，95%CI 0.96 - 0.99；P = 0.023）、峰值代谢当量（HR 0.83，95%CI 0.70 - 0.99，P = 0.034）和中度二尖瓣反流（HR 5.02，95%CI 1.42 - 17.75，P = 0.012）。
由CP定义的亚临床动脉粥样硬化可预测EE阴性的肥胖患者发生AE。这些患者可能从积极的预防措施中获益。
