Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management.
Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management.
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DOI：
10.1161/circulationaha.117.029617
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发表时间：
2018-03-27
期刊：
影响因子：
37.8
通讯作者：
Després JP
中科院分区：
文献类型：
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作者：
Neeland IJ;Poirier P;Després JP
在过去二十年中，肥胖症的流行率在全球范围内有所增加。虽然体重指数（BMI）是一个方便和简单的指数肥胖在人口水平上，研究表明，肥胖定义的BMI单独是一个显着的异质性条件与不同的心血管（CV）和代谢表现在个人之间。脂肪组织是一种非常活跃的代谢器官，参与各种系统之间的相互作用;其干扰导致易感个体对正热量平衡的病理反应，直接和间接导致CV和代谢疾病。面对饮食甘油三酯，皮下脂肪组织扩张不足导致内脏和异位脂肪沉积、炎症/脂肪因子失调和胰岛素抵抗。相反，优先储存在下半身的脂肪库可以作为代谢缓冲，并保护其他组织免受脂质溢出和异位脂肪引起的脂毒性。过去30年的转化、流行病学和临床研究已经清楚地表明内脏和异位脂肪与以致动脉粥样硬化性血脂异常、高胰岛素血症/葡萄糖耐受不良、高血压、动脉粥样硬化和不良心脏重塑/心力衰竭为特征的临床综合征的发展之间存在密切联系。当考虑代谢健康肥胖表型和肥胖悖论等临床实体时，这种关系甚至更加微妙。尽管很明显内脏/异位脂肪的积累是高于BMI的CV和代谢风险的主要因素，但在临床实践中实施脂肪分布评估仍然是一项挑战。肥胖的人体测量指标很容易实现，但新的成像为基础的方法提供了更高的灵敏度和特异性测量特定的仓库。生活方式、药物和手术干预允许采用多学科方法治疗超重/肥胖，这可能会改善结局，并与公共卫生信息保持一致，以对抗全球日益增长的肥胖流行病，并建立更健康的生活，免于心血管疾病。
The prevalence of obesity has increased globally over the last two decades. Although the body mass index (BMI) has been a convenient and simple index of obesity at the population level, studies have shown that obesity defined by BMI alone is a remarkably heterogeneous condition with varying cardiovascular (CV) and metabolic manifestations across individuals. Adipose tissue is an exquisitely active metabolic organ engaged in cross-talk between various systems; perturbation of which results in a pathologic response to positive caloric balance in susceptible individuals that directly and indirectly contributes to CV and metabolic disease. Inadequate subcutaneous adipose tissue expansion in the face of dietary triglycerides leads to visceral and ectopic fat deposition, inflammatory/adipokine dysregulation, and insulin resistance. Conversely, preferential fat storage in the lower body depot may act as a metabolic buffer and protect other tissues from lipotoxicity caused by lipid overflow and ectopic fat. Translational, epidemiologic, and clinical studies over the past 30 years have clearly demonstrated a strong link between visceral and ectopic fat and the development of a clinical syndrome characterized by atherogenic dyslipidemia, hyperinsulinemia/glucose intolerance, hypertension, atherosclerosis, and adverse cardiac remodeling/heart failure. This relationship is even more nuanced when clinical entities such as metabolically healthy obesity phenotype and the obesity paradox are considered. Although it is clear that the accumulation of visceral/ectopic fat is a major contributor to CV and metabolic risk above and beyond the BMI, implementation of fat distribution assessment into clinical practice remains a challenge. Anthropometric indices of obesity are easily implemented but newer imaging-based methods offer improved sensitivity and specificity for measuring specific depots. Lifestyle, pharmacologic, and surgical interventions allow a multidisciplinary approach to overweight/obesity that may improve outcomes and align with a public health message to combat the growing epidemic of obesity worldwide and build healthier lives, free of cardiovascular diseases.