Ayo-Martin Oscar, García-García Jorge, Hernández-Fernández Francisco, Gómez-Hontanilla Mercedes, Gómez-Fernández Isabel, Andrés-Fernández Carolina, Lamas Cristina, Alfaro-Martínez José Joaquín, Botella Francisco, Segura Tomás
Neurology Department, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla-La Mancha, C/ Hermanos Falcó, 37, 02008, Albacete, Spain.
Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
Geroscience. 2021 Jun;43(3):1465-1479. doi: 10.1007/s11357-020-00313-x. Epub 2021 Jan 15.
Overweight and obesity are well-known independent risk factors for stroke in the general population although uncertain in the case of the elderly, according to the obesity paradox. Little is known about underlying mechanisms. Our study aims to assess whether there is a relationship between excess body weight (measured as waist circumference) and poor cerebral hemodynamics (measured by transcranial Doppler parameters: basal, mean flow velocity (MFV), and dynamic, cerebrovascular reserve (CvR) in the right middle cerebral artery (RMCA)). A possible underlying molecular mechanism was analyzed via plasma leptin, adiponectin, TNF-α, IL-6, VCAM, and CRP levels. One hundred sixty-five subjects were included. Bivariate and multivariate regression showed a linear correlation between waist circumference and hemodynamics in RMCA, with clear gender effects: MFV (global NS, men β - 0.26 p < 0.01; women NS), CvR (global: β - 0.15 p < 0.01; men: β - 0.29 p < 0.01, women: β - 0.19 p < 0.09). For subjects above 65 years, there is no significant relationship between AbP and cerebral hemodynamics. In multivariate regression models, only leptin correlated independently with MFV in RMCA (β 7.24, p < 0.01) and CvR (β - 0.30, p < 0.01). In both cases, waist circumference remains significantly related to both parameters. There is an inverse linear correlation between excess body weight and cerebral hemodynamics, independent of other vascular risk factors and clearly influenced by gender. This relation disappears in the elderly population. Leptin might play a role in this relationship. Nevertheless, there must be another associated mechanism, not identified in this study.
超重和肥胖是一般人群中公认的中风独立危险因素，不过根据肥胖悖论，在老年人中情况尚不确定。其潜在机制知之甚少。我们的研究旨在评估超重（以腰围衡量）与脑血流动力学不良（通过经颅多普勒参数测量：右侧大脑中动脉（RMCA）的基础平均血流速度（MFV）和动态脑血管储备（CvR））之间是否存在关联。通过血浆瘦素、脂联素、TNF-α、IL-6、血管细胞黏附分子（VCAM）和C反应蛋白（CRP）水平分析了一种可能的潜在分子机制。纳入了165名受试者。双变量和多变量回归显示腰围与RMCA的血流动力学之间存在线性相关性，且存在明显的性别效应：MFV（总体无显著性差异，男性β - 0.26，p < 0.01；女性无显著性差异），CvR（总体：β - 0.15，p < 0.01；男性：β - 0.29，p < 0.01，女性：β - 0.19，p < 0.09）。对于65岁以上的受试者，腹围与脑血流动力学之间无显著关系。在多变量回归模型中，只有瘦素与RMCA的MFV（β 7.24，p < 0.01）和CvR（β - 0.30，p < 0.01）独立相关。在这两种情况下，腰围与这两个参数仍显著相关。超重与脑血流动力学之间存在负线性相关性，独立于其他血管危险因素，且明显受性别影响。这种关系在老年人群中消失。瘦素可能在这种关系中起作用。然而，必定存在另一种未在本研究中确定的相关机制。
