Long-term Successful Weight Loss Improves Vascular Endothelial Function in Severely Obese Individuals
Long-term Successful Weight Loss Improves Vascular Endothelial Function in Severely Obese Individuals
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DOI：
10.1038/oby.2009.482
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发表时间：
2010-04-01
期刊：
影响因子：
6.9
通讯作者：
Gokce, Noyan
中科院分区：
文献类型：
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作者：
Bigornia, Sherman J.;Mott, Melanie M.;Gokce, Noyan
肥胖与心血管风险增加有关。虽然短期的体重减轻可以改善血管内皮功能，但长期的结果还没有得到广泛的研究。我们检测了29名体重下降≥ 10%的重度肥胖受试者（年龄45 ± 13岁; BMI 48 ± 9 kg/m2）的肱动脉内皮依赖性血管舒张和代谢参数，这些受试者在基线和饮食和/或手术干预12个月后。我们将这些参数与14名减肥失败的肥胖个体（年龄49 ± 11岁; BMI 39 ± 7 kg/m2）进行了比较。对于整个组，平均肱动脉血流介导的扩张（FMD）受损为6.7 ± 4.1%。持续体重减轻后，FMD从6.8 +/-4.2%显著增加至10.0 +/-4.7%，但在体重未下降的患者中保持钝化，从6.5 +/-4.0%至5.7 +/-4.1%，ANOVA分析P = 0.013。内皮非依赖性，硝酸甘油介导的扩张（NMD）是不变的。体重干预成功后，BMI下降了13 +/- 7 kg/m2，并与总胆固醇和低密度脂蛋白胆固醇、葡萄糖、血红蛋白A（1c）和高敏C反应蛋白（CRP）降低相关。血管改善与血糖水平相关性最强（r =-0.51，P = 0.002），与体重变化无关。在这个严重肥胖受试者队列中，1年的持续体重减轻改善了血管功能和代谢参数。研究结果表明，逆转内皮功能障碍和恢复动脉稳态可能会降低心血管风险。结果还表明，与体重减轻相关的代谢变化是比体重减轻程度更强的血管表型决定因素。
Obesity is associated with increased cardiovascular risk. Although short-term weight loss improves vascular endothelial function, longer term outcomes have not been widely investigated. We examined brachial artery endothelium-dependent vasodilation and metabolic parameters in 29 severely obese subjects who lost >= 10% body weight (age 45 +/- 13 years; BMI 48 +/- 9 kg/m(2)) at baseline and after 12 months of dietary and/or surgical intervention. We compared these parameters to 14 obese individuals (age 49 +/- 11 years; BMI 39 +/- 7 kg/m(2)) who failed to lose weight. For the entire group, mean brachial artery flow-mediated dilation (FMD) was impaired at 6.7 +/- 4.1%. Following sustained weight loss, FMD increased significantly from 6.8 +/- 4.2 to 10.0 +/- 4.7%, but remained blunted in patients without weight decline from 6.5 +/- 4.0 to 5.7 +/- 4.1%, P = 0.013 by ANOVA. Endothelium-independent, nitroglycerin-mediated dilation (NMD) was unaltered. BMI fell by 13 +/- 7 kg/m(2) following successful weight intervention and was associated with reduced total and low-density lipoprotein cholesterol, glucose, hemoglobin A(1c), and high-sensitivity C-reactive protein (CRP). Vascular improvement correlated most strongly with glucose levels (r = -0.51, P = 0.002) and was independent of weight change. In this cohort of severely obese subjects, sustained weight loss at 1 year improved vascular function and metabolic parameters. The findings suggest that reversal of endothelial dysfunction and restoration of arterial homeostasis could potentially reduce cardiovascular risk. The results also demonstrate that metabolic changes in association with weight loss are stronger determinants of vascular phenotype than degree of weight reduction.