Department of Radiology, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, China.
Cardiovasc Diabetol. 2024 Apr 2;23(1):120. doi: 10.1186/s12933-024-02208-z.
Obesity is often associated with multiple comorbidities. However, whether obese subjects with hyperlipidemia in the absence of other complications have worse cardiac indices than metabolically healthy obese subjects is unclear. Therefore, we aimed to determine the effect of hyperlipidemia on subclinical left ventricular (LV) function in obesity and to evaluate the association of cardiac parameters with body fat distribution.
Ninety-two adults were recruited and divided into 3 groups: obesity with hyperlipidemia (n = 24, 14 males), obesity without hyperlipidemia (n = 25, 13 males), and c ntrols (n = 43, 25 males). LV strain parameters (peak strain (PS), peak diastolic strain rate (PDSR), peak systolic strain rate) derived from cardiovascular magnetic resonance tissue tracking were measured and compared. Dual-energy X-ray absorptiometer was used to measure body fat distribution. Correlations of hyperlipidemia and body fat distribution with LV strain were assessed by multivariable linear regression.
Obese individuals with preserved LV ejection fraction showed lower global LV longitudinal, circumferential, and radial PS and longitudinal and circumferential PDSR than controls (all P < 0.05). Among obese patients, those with hyperlipidemia had lower longitudinal PS and PDSR and circumferential PDSR than those without hyperlipidemia (- 12.8 ± 2.9% vs. - 14.2 ± 2.7%, 0.8 ± 0.1 s vs. 0.9 ± 0.3 s, 1.2 ± 0.2 s vs. 1.4 ± 0.2 s; all P < 0.05). Multivariable linear regression demonstrated that hyperlipidemia was independently associated with circumferential PDSR (β = - 0.477, P < 0.05) in obesity after controlling for growth differences, other cardiovascular risk factors, and central fat distribution. In addition, android fat had an independently negative relationship with longitudinal and radial PS (β = - 0.486 and β = - 0.408, respectively; all P < 0.05); and visceral fat was negatively associated with longitudinal PDSR (β = - 0.563, P < 0.05). Differently, gynoid fat was positively correlated with circumferential PS and PDSR and radial PDSR (β = 0.490, β = 0.481, and β = 0.413, respectively; all P < 0.05).
Hyperlipidemia is independently associated with subclinical LV diastolic dysfunction in obesity. Central fat distribution (android and visceral fat) has a negative association, while peripheral fat distribution (gynoid fat) has a positive association on subclinical LV function. These results suggest that appropriate management of hyperlipidemia may be beneficial for obese patients, and that the differentiation of fat distribution in different regions may facilitate the precise management of obese patients. Clinical trials registration Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).
肥胖常与多种合并症相关。然而，高脂血症合并其他并发症的肥胖患者的心脏指数是否比代谢健康的肥胖患者差尚不清楚。因此，我们旨在确定高脂血症对肥胖患者亚临床左心室（LV）功能的影响，并评估心脏参数与体脂分布的相关性。
招募了 92 名成年人，并将其分为 3 组：肥胖伴高脂血症（n=24，男性 14 人）、肥胖不伴高脂血症（n=25，男性 13 人）和对照组（n=43，男性 25 人）。使用心血管磁共振组织追踪技术测量 LV 应变参数（峰值应变（PS）、峰值舒张应变率（PDSR）、峰值收缩应变率），并进行比较。双能 X 射线吸收仪用于测量体脂分布。采用多元线性回归评估高脂血症和体脂分布与 LV 应变的相关性。
射血分数保留的肥胖个体的整体 LV 纵向、周向和径向 PS 以及纵向和周向 PDSR 低于对照组（均 P<0.05）。在肥胖患者中，高脂血症患者的纵向 PS 和 PDSR 以及周向 PDSR 低于无高脂血症患者（-12.8%±2.9%比-14.2%±2.7%，0.8±0.1s 比 0.9±0.3s，1.2±0.2s 比 1.4±0.2s；均 P<0.05）。多元线性回归表明，在控制生长差异、其他心血管危险因素和中心性脂肪分布后，高脂血症与肥胖患者的周向 PDSR 独立相关（β=-0.477，P<0.05）。此外，男性型脂肪与纵向和径向 PS 呈负相关（β=-0.486 和 β=-0.408；均 P<0.05）；而内脏脂肪与纵向 PDSR 呈负相关（β=-0.563，P<0.05）。相反，女性型脂肪与周向 PS 和 PDSR 以及径向 PDSR 呈正相关（β=0.490、β=0.481 和 β=0.413；均 P<0.05）。
高脂血症与肥胖患者的亚临床 LV 舒张功能障碍独立相关。中心性脂肪分布（男性型和内脏型脂肪）与亚临床 LV 功能呈负相关，而外周性脂肪分布（女性型脂肪）与亚临床 LV 功能呈正相关。这些结果表明，适当的高脂血症管理可能对肥胖患者有益，并且不同区域的脂肪分布差异可能有助于肥胖患者的精准管理。
基于智能手机软件的肥胖患者生活方式干预对代谢的影响（ChiCTR1900026476）。
