Lahey Ryan, Khan Sadiya S
Department of Medicine, Northwestern University Feinberg School of Medicine.
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine.
Curr Epidemiol Rep. 2018 Sep;5(3):243-251. doi: 10.1007/s40471-018-0160-1. Epub 2018 Jul 9.
The obesity epidemic is a global health crisis of staggering proportion. Excess body weight is a major risk factor for the development of cardiovascular disease (CVD). We review temporal trends in obesity rates, pertinent pathophysiology to understand mechanisms of disease, and treatment strategies in the context of reducing cardiovascular risk.
The prevalence of obesity is increasing in recent decades and is driven by a complex interplay of economic, environmental, and biological factors. In developed countries, changes in foodintake, such as increased consumption of energy-dense and added sugar have contributed significantly to weight gain. Single nucleotide variations in genes and alterations in the gut microbiome have been associated with the obese phenotype. The description of an obesity paradox in patients with CVD may have several explanations, including limitations of body mass index (BMI) to assess adiposity, selection bias, and lead-time bias with earlier onset of disease. Evidence-based treatments for weight loss include lifestyle intervention, pharmacotherapy, and bariatric surgery. Data on the long-term effects of these therapies on cardiovascular risk are limited.
Overweight and obesity are associated with increased cardiovascular morbidity and mortality over the lifespan. Despite our increasing understanding of biological and environmental drivers of obesity, more work is needed in developing effective prevention strategies and implementation of evidence-based treatments to promote cardiovascular health and reduce cardiovascular risk. Ultimately, efforts to prevent and postpone cardiovascular morbidity should include focus on maintenance of normal BMI (primordial prevention) for a longer and healthier life, free of CVD.
肥胖流行是一场规模惊人的全球健康危机。超重是心血管疾病（CVD）发生的主要危险因素。我们回顾肥胖率的时间趋势、理解疾病机制的相关病理生理学以及降低心血管风险背景下的治疗策略。
近几十年来肥胖患病率不断上升，其由经济、环境和生物因素的复杂相互作用所驱动。在发达国家，食物摄入的变化，如能量密集型食物和添加糖消费的增加，对体重增加有显著影响。基因中的单核苷酸变异和肠道微生物群的改变与肥胖表型有关。CVD患者中肥胖悖论的描述可能有多种解释，包括体重指数（BMI）评估肥胖的局限性、选择偏倚以及疾病早发导致的领先时间偏倚。基于证据的减肥治疗方法包括生活方式干预、药物治疗和减肥手术。这些疗法对心血管风险的长期影响数据有限。
超重和肥胖与一生中心血管发病率和死亡率的增加相关。尽管我们对肥胖的生物和环境驱动因素的理解不断加深，但仍需要开展更多工作来制定有效的预防策略并实施基于证据的治疗方法，以促进心血管健康并降低心血管风险。最终，预防和推迟心血管疾病发病的努力应包括关注维持正常BMI（初级预防），以实现更长寿、更健康且无CVD的生活。
