Department of Cardiology, Bern University Hospital-INSELSPITAL, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland.
Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Antwerp 2650, Belgium.
Eur Heart J. 2024 Oct 7;45(38):4063-4098. doi: 10.1093/eurheartj/ehae508.
The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.
在过去的四十年中，全球肥胖症的患病率增加了一倍多，目前影响到超过 10 亿人。肥胖不仅被认为是一种高风险状况，与许多慢性疾病有因果关系，而且本身就是一种疾病，会导致生活质量受损和预期寿命缩短。值得注意的是，三分之二的与肥胖相关的超额死亡率归因于心血管疾病。尽管肥胖与包括动脉粥样硬化疾病、心力衰竭、血栓栓塞性疾病、心律失常和心源性猝死在内的广泛心血管疾病表现之间的关联日益受到重视，但与其他可改变的心血管危险因素相比，肥胖症的认识仍然不足，处理也不够理想。鉴于肥胖症流行对公众健康的重大影响，人们关注的重点是基于人群的和个性化的方法，以防止体重过度增加和保持从儿童早期到成年期的健康体重，以及针对已患有肥胖症的人群进行全面的减肥干预。欧洲心脏病学会的这份临床共识声明讨论了肥胖症的流行病学和病因学、肥胖症与心血管危险因素和心脏疾病之间的相互作用、患有心脏疾病和肥胖症的患者的临床管理，以及减肥策略，包括生活方式改变、介入性手术和抗肥胖药物，特别关注它们对心脏代谢风险和心脏结局的影响。该文件旨在提高对肥胖症作为主要危险因素的认识，并为在一级和二级心血管疾病预防的背景下实施预防和最佳管理肥胖症的循证实践提供指导。
