Lopez-Jimenez Francisco, Almahmeed Wael, Bays Harold, Cuevas Ada, Di Angelantonio Emanuele, le Roux Carel W, Sattar Naveed, Sun Marie Chan, Wittert Gary, Pinto Fausto J, Wilding John P H
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
Eur J Prev Cardiol. 2022 Dec 7;29(17):2218-2237. doi: 10.1093/eurjpc/zwac187.
The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life, and >2.8 million deaths each year. Obesity is relapsing, progressive, and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognizing resource and support variances between countries).
持续蔓延的肥胖症流行是一场全球公共卫生危机，导致健康状况不佳、生活质量下降，每年造成超过280万人死亡。肥胖具有复发性、渐进性和异质性。世界肥胖联合会（WOF）将其视为一种慢性病，世界心脏联合会（WHF）则将其视为一种慢性疾病。超重/肥胖人群患心血管（CV）疾病和死亡的风险更高。脂肪增多（身体脂肪），尤其是内脏/腹部脂肪，通过多种直接和间接的病理生理机制与心血管风险和心血管疾病（CVD）相关联。CVD的发展部分是由肥胖相关的代谢、内分泌、免疫、结构、体液、血流动力学和功能改变所驱动的。这些机制的复杂多面性在临床实践中可能难以理解和应对。患有肥胖症和CVD的人通常同时患有慢性身体或心理疾病（多重疾病），需要多学科护理途径和联合用药。有证据表明，有意减肥（尤其是大幅减肥）可降低超重/肥胖人群的CVD风险。长期减肥和维持体重需要个人及其护理人员持续的努力。这份由WOF和WHF制定的立场文件旨在增进对超重/肥胖与CVD之间直接和间接联系、该领域的关键争议以及现有体重管理方案与心脏代谢结果相关证据的理解。最后，一份针对临床医生的行动计划提供了建议，以帮助识别和应对与肥胖相关的CVD风险（认识到各国之间资源和支持的差异）。
