Sun Min, Gao Lei, Bai Hongmei, Hu Weiwei, Zhang Xiaofang, Xiao Jin, Deng Xiangliang, Tao Hongmei, Ge Ping, Qin Yuhong, Zhang Dongying
Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Health Management Center, The First Branch of the Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Diabetes Metab Syndr Obes. 2023 Mar 8;16:653-662. doi: 10.2147/DMSO.S399928. eCollection 2023.
To investigate the association of visceral fat with arterial stiffness of heart failure patients with preserved ejection fraction (HFpEF) and to evaluate the extent to which this association is mediated by blood pressure (BP).
This cross-sectional descriptive study (clinicaltrials.gov identifier: NCT04535726) recruited 94 patients with HFpEF totally from October to December 2020. The obesity-related measurements included visceral fat area (VFA), body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-hip ratio (WC/HC), abdominal circumference (AC), body fat mass and fat percentage. Brachial-ankle pulse wave velocity (baPWV) was used to estimate the degree of arterial stiffness. Mediation analysis was performed to reveal whether the effect of visceral fat area on arterial stiffness can be mediated by BP in patients with HFpEF and the extent to which this association was mediated by BP.
About 93.6% of HFpEF patients were accompanied with abdominal obesity. Patients in baPWV ≥1800cm/s group were older, with a higher incidence of type 2 diabetes mellitus (T2DM), hypertension and abdominal obesity. VFA, systolic BP (SBP), diastolic BP (DBP) and pulse pressure (PP) were correlated with baPWV in total group. Adjusted for age ≥75 years old, gender, smoking, T2DM, calcium channel blocker and statins, the mediation effect of systolic SBP and PP on the VFA-baPWV association were 53.3% (indirect effect was 2.28, 95% CI 0.62-4.73) and 48.4% (indirect effect was 2.07, 95% CI 0.51-4.38), respectively. DBP failed to mediate the association between VFA and baPWV (indirect effect was 0.50, 95% CI -0.41-2.14).
The association of visceral fat with baPWV in HFpEF patients may be partly accounted for SBP or PP. Elevated SBP and PP might be important potential targets for preventing arterial stiffness in HFpEF patients.
探讨射血分数保留的心力衰竭（HFpEF）患者内脏脂肪与动脉僵硬度的关系，并评估血压（BP）介导这种关系的程度。
这项横断面描述性研究（clinicaltrials.gov标识符：NCT04535726）于2020年10月至12月共招募了94例HFpEF患者。与肥胖相关的测量指标包括内脏脂肪面积（VFA）、体重指数（BMI）、腰围（WC）、臀围（HC）、腰臀比（WC/HC）、腹围（AC）、体脂量和脂肪百分比。采用臂踝脉搏波速度（baPWV）评估动脉僵硬度程度。进行中介分析以揭示在HFpEF患者中，内脏脂肪面积对动脉僵硬度的影响是否可由血压介导，以及这种关系由血压介导的程度。
约93.6%的HFpEF患者伴有腹型肥胖。baPWV≥1800cm/s组患者年龄更大，2型糖尿病（T2DM）、高血压和腹型肥胖的发生率更高。在总人群中，VFA、收缩压（SBP）、舒张压（DBP）和脉压（PP）与baPWV相关。在调整年龄≥75岁、性别、吸烟、T2DM、钙通道阻滞剂和他汀类药物后，收缩压和脉压对VFA-baPWV关系的中介效应分别为53.3%（间接效应为2.28，95%CI 0.62 - 4.73）和48.4%（间接效应为2.07，95%CI 0.51 - 4.38）。舒张压未能介导VFA与baPWV之间的关系（间接效应为0.50，95%CI -0.41 - 2.14）。
HFpEF患者内脏脂肪与baPWV之间的关系可能部分由收缩压或脉压解释。收缩压和脉压升高可能是预防HFpEF患者动脉僵硬度的重要潜在靶点。
