肥胖悖论与心血管疾病

超重或肥胖与2型糖尿病、高脂血症和高血压等多种心血管危险因素密切相关。但近年的观察研究表明,已确诊心血管疾病的肥胖患者与患相同心血管疾病的正常体重和消瘦患者相比,具有生存优势。早期肥胖悖论研究主要集中于心力衰竭和冠心病,但最近的数据也表明肥胖悖论还涉及其他心血管疾病,如高血压、心房颤动、肺动脉高压和先天性心脏病。尽管许多研究结果都显示出肥胖悖论,然而关于肥胖悖论的依据以及它是否能让肥胖的心血管疾病患者获益,仍存在大量争论。本综述旨在整理支持和反对肥胖悖论的依据,回顾关于心血管疾病肥胖悖论的假定机制和最新证据,并讨论观察性研究中存在的混杂因素和偏见。

Obesity Paradox and Cardiovascular Diseases

Overweight or obesity are closely related to cardiovascular risk factors such as type 2 diabetes,hyperlipidemia and hypertension.However,recent observational studies have shown that obese patients with confirmed cardiovascular diseases have survival advantages compared with normal weight and lean patients with the same cardiovascular disease.Early obesity paradox investigation focused on heart failure and coronary atherosclerotic heart disease.Recent data shows it may also involve in other cardiovascular diseases like hypertension,atrial fibrillation,pulmonary arterial hypertension and congenital heart disease.Although obesity paradox has been observed in extensive research,its origin and profit are still disputed.This review aims to sort out the basis for supporting and opposing the obesity paradox,review the hypothetical mechanism and the latest evidence about the obesity paradox in cardiovascular diseases,and discuss the confounding factors and biases in observational studies.