肥胖和内脏脂肪会导致心力衰竭吗?
1Baylor Heart and Vascular Institute, Baylor University Medical Center, 621 North Hall Street, Dallas, TX 75226, USA.
European heart journal
|September 2, 2025
概括
肥胖对心力衰竭有显著影响,但其对心力衰竭的作用尚不清楚. 过多的内脏脂肪与HFpEF有关,而与HFrEF的关联需要进一步调查.
科学领域:
- 心脏病学
- 代谢综合征
- 肥胖研究
背景情况:
- 肥胖和内脏脂肪是心力衰竭的关键因子.
- 相比之下,肥胖不是早期心力衰竭与减少喷射率 (HFrEF) 研究的突出特征,甚至被认为是保护性的.
- 中部脂肪预测HFpEF的发展,但在一般人群中没有HFrEF.
研究的目的:
- 研究肥胖和内脏脂肪在HFpEF与HFrEF发病和进展中的不同作用.
- 探索脂肪标志物,全身炎症和心力衰竭亚型之间的关系.
- 评估肥胖对HFpEF和HFrEF治疗反应的影响.
主要方法:
- 在HFpEF和HFrEF队列中对肥胖和脂肪标志物的比较分析 (腰与身高的比,心上脂肪组织).
- 与心力衰竭类型相关的全身炎症标志物 (hsCRP) 和皮素 (叶丁,皮素) 的评估.
- 根据肥胖状况对治疗反应的评估 (矿物质皮质类受体抗剂,尼普利辛抑制剂,SGLT2抑制剂,基于基的药物).
主要成果:
- 心上脂肪组织的扩张和腰部与身高的比率的增加与HFpEF有关,而心上脂肪的减少与HFrEF预后的恶化有关.
- 高hsCRP预测HFpEF的发展,可能是由于脂肪驱动的炎症,与HFrEF不同,它可能与动脉样硬化或阻塞有关.
- 肥胖不同于HFpEF (由脂肪驱动) 和HFrEF (由心脏/神经激素信号驱动) 的影响.
- 中部肥胖症患者可能会对HFpEF和HFrEF的某些疗法产生反应,但治疗疗效因HF类型而异.
结论:
- 肥胖和内脏脂肪是HFpEF的基本驱动因素,与HFrEF相比具有不同的病理生理作用.
- 肥胖标志物和相关炎症提供了对HFpEF和HFrEF的差异见解.
- 了解肥胖在HFrEF中的作用对于完善治疗策略和改善患者结果至关重要.
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