"Sick Fat," Metabolic Disease, and Atherosclerosis
"Sick Fat," Metabolic Disease, and Atherosclerosis
复制标题
DOI：
10.1016/j.amjmed.2008.10.015
复制
发表时间：
2009-01-01
影响因子：
5.9
通讯作者：
Bays, Harold E.
中科院分区：
文献类型：
--
作者：
Bays, Harold E.
动脉粥样硬化性冠心病（CHD）是发达国家男性和女性发病和死亡的最常见原因。肥胖的流行导致高血糖（如糖尿病和代谢综合征患者）、高血压和血脂异常的患病率增加，这些都是冠心病的危险因素。代谢综合征描述的是一种常见的临床发现，其中冠心病的危险因素集中在一个病人身上，但这个术语并不能确定任何统一的病理生理过程。然而，代谢综合征的一个组成部分是腹部肥胖，这确实反映了一种“共同土壤”病理生理过程的解剖表现，该过程促进了冠心病危险因素的发生，从而增加了冠心病的风险。脂肪病（“病态脂肪”）的解剖学特征是内脏脂肪和脂肪细胞肥大；它在生理上表现为游离脂肪酸释放的净增加和致病脂肪组织代谢/免疫反应，从而促进代谢性疾病和增加冠心病风险。了解脂肪病变与冠心病危险因素的关系，认识到治疗代谢性疾病的“因果关系”的重要性，对于全面降低冠心病风险至关重要。关于“原因”，临床医生和他们的病人应该认真考虑适当的营养和生活方式干预，这可能有利于健康。关于“效果”，当营养和生活方式干预不能充分达到预期的代谢治疗目标时，临床医生和他们的患者应该同样努力地采取适当的药物干预来减少冠心病的危险因素。(c) 2009年Elsevier Inc.出版美国医学杂志（2009）122,S26-S37
Atherosclerotic coronary heart disease (CHD) is the most common cause of morbidity and mortality among men and women in developed nations. The obesity epidemic contributes to the increasing prevalence of high blood sugar (as may be found in patients with diabetes mellitus and metabolic syndrome), high blood pressure, and dyslipidemia-all CHD risk factors. Metabolic syndrome describes the common clinical finding wherein component CHD risk factors cluster within a single patient, but this term does not identify any unified pathophysiologic process. However, a component of the metabolic syndrome is abdominal obesity, which does reflect an anatomic manifestation of a "common-soil" pathophysiologic process that promotes the onset of CHD risk factors, and thus increases CHD risk. Adiposopathy ("sick fat") is anatomically characterized by visceral adiposity and adipocyte hypertrophy; it is manifested physiologically by a net increase in release of free fatty acids and by pathogenic adipose tissue metabolic/immune responses that promote metabolic disease and increase CHD risk. Understanding the relation of adiposopathy to CHD risk factors and recognizing the importance of treating both the "cause and effect" of metabolic diseases are critical toward a comprehensive approach in reducing CHD risk. Regarding the "cause," clinicians and their patients should be diligent regarding appropriate nutritional and lifestyle interventions that may favorably affect health. Regarding the " effect," clinicians and their patients should be equally diligent toward appropriate pharmaceutical interventions that reduce CHD risk factors when nutritional and lifestyle interventions do not sufficiently achieve desired metabolic treatment goals. (c) 2009 Published by Elsevier Inc. The American Journal of Medicine (2009) 122, S26-S37