The Relationship of Body Mass and Fat Distribution With Incident Hypertension Observations From the Dallas Heart Study
The Relationship of Body Mass and Fat Distribution With Incident Hypertension Observations From the Dallas Heart Study
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DOI：
10.1016/j.jacc.2014.05.057
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发表时间：
2014-09-09
影响因子：
24
通讯作者：
Turer, Aslan T.
中科院分区：
文献类型：
--
作者：
Chandra, Alvin;Neeland, Ian J.;Turer, Aslan T.
肥胖与高血压的发生有关，但究竟是完全肥胖还是部位特异性脂肪堆积支撑了这种关系尚不清楚。目的：本研究旨在确定脂肪组织分布与高血压发病之间的关系。方法：对参加达拉斯心脏研究的血压正常的参与者进行中位数为7年的高血压发展随访（收缩压[SBP] >= 140 mm Hg，舒张压>= 90 mm Hg，或开始降压药物）。采用磁共振成像和质子光谱成像对内脏脂肪组织（VAT）和皮下脂肪组织（SAT）进行定量，采用双能x线吸收仪对下体脂肪（LBF）进行定量。在调整年龄、性别、种族/民族、糖尿病、吸烟、收缩压和体重指数（BMI）等因素后，采用多变量相对风险回归检验个体脂肪储备与高血压发病率之间的关系。结果在903名参与者中（中位年龄40岁，57%为女性，60%为非白人，中位BMI为27.5 kg/m(2)）， 230人（25%）发生高血压。在多变量分析中，较高的BMI与高血压事件显著相关（相对危险度：1.24；95%可信区间：1.12 - 1.36，每增加1-SD）。然而，当将VAT、SAT和LBF加入模型时，只有VAT仍然与高血压事件独立相关（相对风险：1.22；95%置信区间：1.06至1.39，每增加1-SD）。结论：内脏脂肪的增加，而不是全身或皮下脂肪的增加，与高血压的发生密切相关。需要进一步的研究来阐明这种关联背后的机制。(C) 2014年由美国心脏病学会基金会发布。
BACKGROUND Obesity has been linked to the development of hypertension, but whether total adiposity or site-specific fat accumulation underpins this relationship is unclear.OBJECTIVES This study sought to determine the relationship between adipose tissue distribution and incident hypertension.METHODS Normotensive participants enrolled in the Dallas Heart Study were followed for a median of 7 years for the development of hypertension (systolic blood pressure [SBP] >= 140 mm Hg, diastolic blood pressure >= 90 mm Hg, or initiation of blood pressure medications). Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) was quantified by magnetic resonance imaging and proton-spectroscopic imaging, and lower body fat (LBF) was imaged by dual-energy x-ray absorptiometry. Multivariable relative risk regression was performed to test the association between individual fat depots and incident hypertension, adjusting for age, sex, race/ethnicity, diabetes, smoking, SBP, and body mass index (BMI).RESULTS Among 903 participants (median age, 40 years; 57% women; 60% nonwhite; median BMI 27.5 kg/m(2)), 230 (25%) developed incident hypertension. In multivariable analyses, higher BMI was significantly associated with incident hypertension (relative risk: 1.24; 95% confidence interval: 1.12 to 1.36, per 1-SD increase). However, when VAT, SAT, and LBF were added to the model, only VAT remained independently associated with incident hypertension (relative risk: 1.22; 95% confidence interval: 1.06 to 1.39, per 1-SD increase).CONCLUSIONS Increased visceral adiposity, but not total or subcutaneous adiposity, was robustly associated with incident hypertension. Additional studies will be needed to elucidate the mechanisms behind this association. (C) 2014 by the American College of Cardiology Foundation.