Henning Robert J
James A. Haley Hospital, University of South Florida Tampa, Florida 33612-3805, USA.
Am J Cardiovasc Dis. 2021 Aug 15;11(4):504-529. eCollection 2021.
Two billion people worldwide older than 18 years of age, or approximately 30% of the world population, are overweight or obese. In addition, more than 43 million children under the age of 5 are overweight or obese. Among the population in the United States aged 20 and greater, 32.8 percent are overweight and 39.8 percent are obese. Blacks in the United States have the highest age-adjusted prevalence of obesity (49.6%), followed by Hispanics (44.8%), whites (42.2%) and Asians (17.4%). The impact of being overweight or obese on the US economy exceeds $1.7 trillion dollars, which is equivalent to approximately eight percent of the nation's gross domestic product. Obesity causes chronic inflammation that contributes to atherosclerosis and causes >3.4 million deaths/year. The pathophysiologic mechanisms in obesity that contribute to inflammation and atherosclerosis include activation of adipokines/cytokines and increases in aldosterone in the circulation. The adipokines leptin, resistin, IL-6, and monocyte chemoattractant protein activate and chemoattract monocytes/macrophages into adipose tissue that promote visceral adipose and systemic tissue inflammation, oxidative stress, abnormal lipid metabolism, insulin resistance, endothelial dysfunction, and hypercoagulability that contribute to atherosclerosis. In addition in obesity, the adipokines/cytokines IL-1β, IL-18, and TNF are activated and cause endothelial cell dysfunction and hyperpermeability of vascular endothelial junctions. Increased aldosterone in the circulation not only expands the blood volume but also promotes platelet aggregation, vascular endothelial dysfunction, thrombosis, and fibrosis. In order to reduce obesity and obesity-induced inflammation, therapies including diet, medications, and bariatric surgery are discussed that should be considered in patients with BMIs>35-40 kg/m if diet and lifestyle interventions fail to achieve weight loss. In addition, antihypertensive therapy, plasma lipid reduction and glucose lowering therapy should be prescribed in obese patients with hypertension, a 10-year CVD risk >7.5%, or prediabetes or diabetes.
全球有20亿18岁以上的人超重或肥胖，约占世界人口的30%。此外，超过4300万5岁以下儿童超重或肥胖。在美国20岁及以上的人群中，32.8%超重，39.8%肥胖。美国黑人年龄调整后的肥胖患病率最高（49.6%），其次是西班牙裔（44.8%）、白人（42.2%）和亚洲人（17.4%）。超重或肥胖对美国经济的影响超过1.7万亿美元，约占美国国内生产总值的8%。肥胖会引发慢性炎症，导致动脉粥样硬化，每年造成超过340万人死亡。肥胖中导致炎症和动脉粥样硬化的病理生理机制包括脂肪因子/细胞因子的激活以及循环中醛固酮的增加。脂肪因子瘦素、抵抗素、白细胞介素-6和单核细胞趋化蛋白激活并趋化单核细胞/巨噬细胞进入脂肪组织，促进内脏脂肪和全身组织炎症、氧化应激、异常脂质代谢、胰岛素抵抗、内皮功能障碍和高凝状态，这些都有助于动脉粥样硬化的发生。此外，在肥胖状态下，脂肪因子/细胞因子白细胞介素-1β、白细胞介素-18和肿瘤坏死因子被激活，导致内皮细胞功能障碍和血管内皮连接的高通透性。循环中醛固酮增加不仅会使血容量增加，还会促进血小板聚集、血管内皮功能障碍、血栓形成和纤维化。为了减轻肥胖及肥胖引起的炎症，本文讨论了包括饮食、药物和减肥手术在内的治疗方法，对于体重指数（BMI）>35 - 40kg/m²且饮食和生活方式干预未能实现体重减轻的患者应予以考虑。此外，对于患有高血压、10年心血管疾病风险>7.5%、或患有糖尿病前期或糖尿病的肥胖患者，应进行抗高血压治疗、降低血脂治疗和降糖治疗。
