JAHA:心衰住院及全因死亡,更应关注内脏脂肪、心包脂肪,而不仅仅是BMI、腰围

2021-07-26 心血管健康联盟 心血管健康联盟

众所周知,肥胖是多类心血管疾病的危险因素。而说到肥胖,我们首先想到的一般是 体重指数(BMI)、腰围、腰臀比 等脂肪量累积或测量,但肥胖对心血管系统的危害,更可能归因于体内 局部脂肪 的分布。

众所周知,肥胖是多类血管疾病的危险因素。而说到肥胖,我们首先想到的一般是 体重指数(BMI)、腰围、腰臀比 等脂肪量累积或测量,但肥胖对心血管系统的危害,更可能归因于体内 局部脂肪 的分布。

其中, 内脏脂肪组织(VAT) 主要存在于腹腔内,包绕相关脏器,不包括皮下脂肪组织(SAT)和肌内脂肪。有人会说了,腰围、腰臀比不就能间接代表腹部的内脏脂肪吗?一定程度上是可以,但并不能够准确量化内脏脂肪和皮下脂肪。

相比BMI、腰围等,内脏脂肪与心血管疾病的相关性可谓更强。美国杜克大学学者专门分析了在黑人群体中,内脏脂肪、心包脂肪、皮下脂肪与心衰住院、全因死亡的相关程度,结果已发表在了美国心脏协会杂志《JAHA》上。

研究共选取了 杰克逊心脏研究 中的2844例无心衰病史参与者,平均年龄59.4岁,男性占比35%,54%合并肥胖,通过CT测量腹部肥胖情况。研究人员分别依据心包脂肪、内脏脂肪或皮下脂肪体积的由低到高,将参与者分别分为Q1-Q4四组。

01 局部脂肪与心衰、全因死亡的相关性

中位随访10.6年后发现, 心包脂肪或内脏脂肪 的量,与心衰住院和全因死亡风险存在正向相关倾向,心包或内脏脂肪最高组的心衰住院率和全因死亡率,均最高。

Figure 1. Cumulative incidence of heart failure and all‐cause mortality by regional adiposity quartiles in the Jackson Heart Study.

Incident heart failure and all‐cause mortality increased in the highest PAT (A and B) and VAT (C and D) quartiles when compared with the lowest quartile. There was no association between the SAT quartiles and incident heart failure (E). All‐cause mortality decreased with the higher SAT quartiles (F). PAT indicates pericardial adipose tissue volume; Q1, quartile 1; Q2, quartile 2; Q3, quartile 3; Q4, quartile 4; SAT, subcutaneous adipose tissue; and VAT, visceral adipose tissue volume.

图片:不同部位脂肪组,脂肪量由低到高(Q1-Q4,依次为绿、蓝、红、黑线)的心衰住院(A、C、E)、全因死亡(B、D、F)累积发生率

皮下脂肪 方面,与心衰住院无显著关联,而与全因死亡似乎呈负相关,皮下脂肪量最低组的全因死亡率为16.4%,最低组降到了10.4%。

02 局部脂肪量与心衰入院

在调整了年龄、性别、吸烟等基线资料后,发现:

心包脂肪 每增加10 cm³,心衰入院风险增加10%;

内脏脂肪 每增加100 cm³,心衰入院风险增加7%;

皮下脂肪每增加100 cm³,心衰入院的风险并未显著增加。

当进一步调整其他心血管危险因素后,风险增加值稍有下降。

03 HFpEF/HFrEF住院

随心包脂肪或内脏脂肪的增加 ,射血分数保留型心衰(HFpEF) 住院风险分别增加13%、7%,而射血分数降低型心衰(HFrEF)住院风险均未显著增加。

04 局部脂肪量与全因死亡

同样是调整基线资料后结果,可见:心包脂肪 每增加10 cm³,心衰入院风险增加12%;内脏脂肪每增加100 cm³,心衰入院风险增加3%;皮下脂肪每增加100 cm³,心衰入院的风险未显著增加。而当调整其他心血管危险因素后,内脏脂肪的显著性风险增加消失。

该项美国黑人大型社区队列研究认为,人体内较高的 心包或内脏脂肪 含量,均与 心衰入院 风险增加相关,其中仅 心包脂肪 与 全因死亡 风险相关,而皮下脂肪与心衰、死亡均无关。

未来的研究,可以关注降低内脏脂肪、心包脂肪,是否更有助于改善心衰,特别是射血分数保留型心衰。

原始出处:

Vishal N. Rao, et al. Regional Adiposity and Risk of Heart Failure and Mortality: The Jackson Heart Study. JAHA. Originally published 9 Jul 2021.

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    2021-07-27 zhaohui6731
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    2021-07-27 naiwu77
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