Department of Geriatric Medicine, Ruijin Hospital North, Shanghai Jiaotong School of Medicine, Shanghai, China.
Daning Community Health Service Center, Shanghai, China.
J Clin Hypertens (Greenwich). 2019 Sep;21(9):1379-1385. doi: 10.1111/jch.13659. Epub 2019 Aug 30.
Obesity is generally considered an undesirable risk factor for cardiovascular disease; however, obese subjects with heart failure paradoxically can have better outcomes than their lean counterparts. This study aimed to investigate this characteristic in an elderly Chinese population. Elderly participants (N = 414, age 77 ± 11 years, 211 males) were recruited from a Chinese community-dwelling elderly population. Subjects were divided into 3 groups according to body mass index (BMI ≤ 25, normal; 25-28, overweight; and ≥28, obese). Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV), and the atherosclerosis status was evaluated with the ankle brachial index (ABI). Brachial systolic blood pressure (BSBP) was significantly higher as BMI increased (135 ± 18.4, 138 ± 18.3, 147 ± 17.6 mm Hg; P = .003) adjusted for age, sex, and heart rate. However, baPWV was significantly lower as BMI increased (baPWV 1830 ± 18, 1793 ± 25, 1704 ± 36 cm/s; P = .008) in the three groups, even with additional adjustment for BSBP. BMI showed a significant negative correlation with baPWV (r = -.170, P = .001) after adjusting for confounding factors. Using multiple linear regression, BMI was negatively and independently associated with baPWV (β = -.190, P < .001) especially for age <80 years. Arterial stiffness, as measured by baPWV, is lower in overweight subjects in a Chinese elderly population compared to those with normal body weight. ABI showed no relationship with BMI. These findings suggest that reduced arterial stiffness in the overweight population, independent of confounding factors, may contribute to the explanation of the "obesity paradox."
肥胖通常被认为是心血管疾病的不良危险因素；然而，心力衰竭的肥胖患者的预后却比消瘦患者好。本研究旨在探讨中国老年人群中这一特征。从中国社区居住的老年人群中招募了 414 名老年参与者（年龄 77 ± 11 岁，男性 211 名）。根据体重指数（BMI≤25，正常；25-28，超重；≥28，肥胖）将受试者分为 3 组。肱踝脉搏波速度（baPWV）评估动脉僵硬度，踝臂指数（ABI）评估动脉粥样硬化状态。调整年龄、性别和心率后，随着 BMI 的增加，肱动脉收缩压（BSBP）显著升高（135 ± 18.4、138 ± 18.3、147 ± 17.6mmHg；P =.003）。然而，在三组中，随着 BMI 的增加，baPWV 显著降低（baPWV 1830 ± 18、1793 ± 25、1704 ± 36cm/s；P =.008），即使在调整 BSBP 后也是如此。调整混杂因素后，BMI 与 baPWV 呈显著负相关（r = -.170，P =.001）。多元线性回归分析显示，BMI 与 baPWV 呈负相关且独立相关（β=-.190，P <.001），尤其是年龄<80 岁者。ABI 与 BMI 无关。这些发现表明，与体重正常者相比，中国老年超重人群的动脉僵硬度（通过 baPWV 测量）较低。动脉粥样硬化的ABI 与 BMI 无关。这些发现表明，与体重正常者相比，中国老年超重人群的动脉僵硬度（通过 baPWV 测量）较低。这些发现表明，与体重正常者相比，中国老年超重人群的动脉僵硬度（通过 baPWV 测量）较低。这些发现表明，与体重正常者相比，中国老年超重人群的动脉僵硬度（通过 baPWV 测量）较低。与 BMI 无关。这些发现表明，与体重正常者相比，中国老年超重人群的动脉僵硬度（通过 baPWV 测量）较低。这些发现表明，与体重正常者相比，中国老年超重人群的动脉僵硬度（通过 baPWV 测量）较低。与 BMI 无关。这些发现表明，与体重正常者相比，中国老年超重人群的动脉僵硬度（通过 baPWV 测量）较低。
动脉僵硬度降低可能是超重人群中“肥胖悖论”的解释之一。
