Obesity and cardiovascular disease.
Obesity and cardiovascular disease.
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DOI：
10.1161/circulationaha.111.022541
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发表时间：
2012-03-06
期刊：
影响因子：
37.8
通讯作者：
Gokce N
中科院分区：
文献类型：
--
作者：
Apovian CM;Gokce N
1178预防心血管疾病。标准饮食和运动策略的疗效有限，因为在6个月后维持体重减轻5%至10%的长期成功率较低。使用食欲抑制剂（通常作用于下丘脑）来减少食物摄入量，只要持续治疗，就可以加强体重减轻;然而，停止使用该药物后体重会迅速恢复。这些药物也充满了副作用，如血压和脉搏升高，焦虑和失眠，因此非常难以使用，特别是在患有心血管疾病或危险因素的患者中。高BMI（V类肥胖）和合并症，如高血压，睡眠呼吸暂停和2型糖尿病，本临床医生更新中的患者肯定会增加心血管风险。他的处方药之一，芬特明，主要作为去甲肾上腺素释放剂和集中抑制食欲下丘脑。由于其类似安非他明的作用，它也会产生脉搏和血压升高的外周效应。在这种程度的肥胖患者中，很可能是睡眠呼吸暂停、可能的右侧心脏超负荷和芬特明效应的组合触发了房颤。肥胖症的药物和手术治疗有一个共同的核心行为方法：饮食和运动调整。这些方法需要与医疗或手术选择同时使用，可能是终身的，以获得成功的结果。该患者无法耐受肥胖治疗的药物选择之一，因为其常见的拟交感神经心血管副作用。不幸的是，许多治疗肥胖的药物由于潜在的心血管和其他副作用而受到了严格的审查，并且在评估健康风险与益处时出现了不足。芬特明于1959年被美国食品和药物管理局（FDA）批准用于减肥，用于短期（12周）治疗肥胖症;长期研究不可用。它与芬氟拉明以一种流行的组合形式结合在一起，称为“phen-fen”，直到对瓣膜病的担忧促使FDA在1997年从市场上撤回芬氟拉明。另一种治疗肥胖的药物西布曲明于1997年被批准长期使用，最近在一项对既存心血管疾病、2型糖尿病或两者兼而有之的受试者进行的研究显示，治疗平均持续时间为3.4年，非致命性心肌梗死和中风的风险增加后，西布曲明被撤出市场。8
1178 ary prevention of cardiovascular disease. Standard diets and exercise strategies have had limited efficacy because of low rates of long-term success in sustaining weight losses of 5% to 10% of initial body weight beyond 6 months. The use of appetite suppressants, which typically work on the hypothalamus, to decrease food intake can potentiate weight loss as long as treatment is sustained; however, weight is quickly regained on cessation of the agent. These drugs are also fraught with side effects such as blood pressure and pulse elevations, anxiety, and insomnia and thus can be extremely difficult to use, especially in patients with cardiovascular disease or risk factors. With a high BMI (class V obesity) and comorbidities such as hypertension, sleep apnea, and type 2 diabetes mellitus, the patient in this Clinician Update is certainly at increased cardiovascular risk. One of his prescribed medications, phentermine, acts primarily as a norepinephrinereleasing agent and centrally suppresses appetite in the hypothalamus. Because of its amphetamine-like actions, it also exerts peripheral effects of pulse and blood pressure elevation. In a patient with this degree of obesity, it is likely that the combination of sleep apnea, possibly right-sided heart overload, and phentermine effects triggered atrial fibrillation. The medical and surgical treatments for obesity have a core of behavioral approaches in common: diet and exercise modification. These modalities need to be included concomitantly with medical or surgical options, likely lifelong, for successful outcomes. This patient was unable to tolerate one of the pharmacotherapeutic options for obesity treatment because of its common sympathomimetic cardiovascular side effects. Unfortunately, many of the medications for obesity have undergone intense scrutiny because of potential cardiovascular and other side effects and have come up short when evaluated for health risk versus benefit. Phentermine was approved for weight loss by the Food andDrug Administration (FDA) in 1959 for short-term (12 weeks) treatment of obesity; long-term studies are unavailable. 7 It was combined with fenfluramine in a popular combination termed “phen-fen” until concerns about valvulopathy prompted the FDA to withdraw fenfluramine from the market in 1997. Another agent for obesity, sibutramine, approved in 1997 for long-term use, was withdrawn from the market recently after a study of subjects with preexisting cardiovascular disease, type 2 diabetes mellitus, or both showed increased risk of nonfatal myocardial infarction and stroke with treatment for a mean duration of 3.4 years. 8