Kortelainen M L, Särkioja T
University of Oulu, Department of Forensic Medicine, Finland.
Int J Obes Relat Metab Disord. 1997 Jan;21(1):43-9. doi: 10.1038/sj.ijo.0800361.
To determine the relationship between cardiovascular pathology and body fat distribution in healthy women with no ante mortem clinical evidence of cardiovascular disease.
Thirty-three female forensic autopsy cases of sudden death from violent causes.
Body height and weight, the circumferences of the waist and hip and the thicknesses of the subscapular and abdominal subcutaneous fat were measured, and Body Mass Index (BMI) and Waist-to-Hip ratio (WHR) were calculated. Omental, mesenterial and perirenal fat deposits were weighted. Heart weight was indexed to height (2.7), the degree of coronary narrowing was determined in each artery, and myocardial collagen volume fraction and myocyte cross-sectional area were measured.
The degree of coronary narrowing, heart weight in absolute terms and indexed to height (2.7), myocyte cross-sectional area and all the measures of obesity were significantly positively correlated with age. Regression of coronary narrowing on measures of obesity indicated that a quadratic model fitted the data for BMI, waist circumference and intra-abdominal fat better than a linear one. After adjusting for age, the degree of coronary narrowing was related to tertiles of BMI, waist circumference, WHR and intra-abdominal fat, the severity of the narrowing being most marked in the second tertile of BMI (24.0-31.0), waist circumference (80-96 cm) and intra-abdominal fat (500-1700 g), but in the third tertile of WHR (over 0.92). Regression on heart weight/height (2.7) on the aforementioned measures of obesity indicated a clearly linear association and heart weight indexed to height (2.7) was related to tertiles of BMI, waist circumference and WHR, and also to tertiles of intra-abdominal fat.
The results suggest that body fatness and abdominal accumulation of fat are associated with the severity of coronary atherosclerosis and myocardial hypertrophy in women with no clinical evidence of cardiovascular disease, but the relationship between coronary lesions and BMI is not linear. Both coronary lesions and myocardial hypertrophy are more advanced as the numerical value for WHR increases in women. Future autopsy studies should be directed at young women with increased WHR in order to determine their risk of developing life-threatening lesions in the atherosclerosis-prone regions of the coronary tree.
确定在生前无心血管疾病临床证据的健康女性中，心血管病理与身体脂肪分布之间的关系。
33例因暴力原因猝死的女性法医尸检病例。
测量身高、体重、腰围和臀围以及肩胛下和腹部皮下脂肪厚度，并计算体重指数（BMI）和腰臀比（WHR）。对网膜、肠系膜和肾周脂肪沉积进行称重。计算心脏重量与身高的指数（2.7），确定每条动脉的冠状动脉狭窄程度，并测量心肌胶原体积分数和心肌细胞横截面积。
冠状动脉狭窄程度、绝对心脏重量以及与身高的指数（2.7）、心肌细胞横截面积和所有肥胖指标均与年龄显著正相关。冠状动脉狭窄程度与肥胖指标的回归分析表明，二次模型比线性模型更适合BMI、腰围和腹内脂肪的数据。在调整年龄后，冠状动脉狭窄程度与BMI、腰围、WHR和腹内脂肪的三分位数相关，狭窄的严重程度在BMI的第二个三分位数（24.0 - 31.0）、腰围（80 - 96厘米）和腹内脂肪（500 - 1700克）中最为明显，但在WHR的第三个三分位数（超过0.92）中也是如此。上述肥胖指标与心脏重量/身高（2.7）的回归分析表明存在明显的线性关系，心脏重量与身高的指数（2.7）与BMI、腰围和WHR的三分位数相关，也与腹内脂肪的三分位数相关。
结果表明，在无心血管疾病临床证据的女性中，身体肥胖和腹部脂肪堆积与冠状动脉粥样硬化的严重程度和心肌肥厚有关，但冠状动脉病变与BMI之间的关系不是线性的。随着女性WHR数值的增加，冠状动脉病变和心肌肥厚都更严重。未来的尸检研究应针对WHR升高的年轻女性，以确定她们在冠状动脉树易发生动脉粥样硬化区域发生危及生命病变的风险。
