背景:肥胖通常与多种合并症相关。然而,在没有其他并发症的情况下患有高脂血症的肥胖受试者的心脏指数是否比代谢健康的肥胖受试者更差尚不清楚.因此,我们旨在确定高脂血症对肥胖者亚临床左心室(LV)功能的影响,并评估心脏参数与体脂分布的相关性.
方法:招募92名成年人,分为3组:肥胖合并高脂血症(n=24,男性14),无高脂血症的肥胖(n=25,13名男性),和cntrols(n=43,男性25)。低压应变参数(峰值应变(PS),峰值舒张应变率(PDSR),测量并比较了来自心血管磁共振组织追踪的收缩期峰值应变率)。采用双能X线骨密度仪测量体脂分布。通过多元线性回归评估高脂血症和体脂分布与LV菌株的相关性。
结果:左心室射血分数保留的肥胖个体表现出更低的左心室纵向,圆周,径向PS和纵向和周向PDSR均优于对照组(均P<0.05)。在肥胖患者中,高脂血症患者的纵向PS和PDSR以及周向PDSR低于无高脂血症患者(-12.8±2.9%vs.-14.2±2.7%,0.8±0.1s-1vs.0.9±0.3s-1,1.2±0.2s-1与1.4±0.2s-1;所有P<0.05)。多变量线性回归表明,控制生长差异后,高脂血症与肥胖的周围PDSR独立相关(β=-0.477,P<0.05)。其他心血管危险因素,和中央脂肪分布。此外,Android脂肪与纵向和径向PS呈独立负相关(β=-0.486和β=-0.408,均P<0.05);内脏脂肪与纵向PDSR呈负相关(β=-0.563,P<0.05)。不同的是,Gynoid脂肪与周向PS、PDSR和放射状PDSR呈正相关(β=0.490,β=0.481,β=0.413,均P<0.05)。
结论:高脂血症与肥胖患者的亚临床左心室舒张功能障碍独立相关。中心脂肪分布(安卓和内脏脂肪)有负相关,而外周脂肪分布(雌核脂肪)与亚临床LV功能呈正相关。这些结果表明,适当的高脂血症管理可能对肥胖患者有益,不同地区脂肪分布的差异可能有助于肥胖患者的精确管理。临床试验注册基于智能手机软件(ChiCTR1900026476)的生活方式干预对肥胖患者代谢的影响。
BACKGROUND: Obesity is often associated with multiple comorbidities. However, whether obese subjects with hyperlipidemia in the absence of other complications have worse cardiac indices than metabolically healthy obese subjects is unclear. Therefore, we aimed to determine the effect of hyperlipidemia on subclinical left ventricular (LV) function in obesity and to evaluate the association of cardiac parameters with body fat distribution.
METHODS: Ninety-two adults were recruited and divided into 3 groups: obesity with hyperlipidemia (n = 24, 14 males), obesity without hyperlipidemia (n = 25, 13 males), and c ntrols (n = 43, 25 males). LV strain parameters (peak strain (PS), peak diastolic strain rate (PDSR), peak systolic strain rate) derived from cardiovascular magnetic resonance tissue tracking were measured and compared. Dual-energy X-ray absorptiometer was used to measure body fat distribution. Correlations of hyperlipidemia and body fat distribution with LV strain were assessed by multivariable linear regression.
RESULTS: Obese individuals with preserved LV ejection fraction showed lower global LV longitudinal, circumferential, and radial PS and longitudinal and circumferential PDSR than controls (all P < 0.05). Among obese patients, those with hyperlipidemia had lower longitudinal PS and PDSR and circumferential PDSR than those without hyperlipidemia (- 12.8 ± 2.9% vs. - 14.2 ± 2.7%, 0.8 ± 0.1 s-1 vs. 0.9 ± 0.3 s-1, 1.2 ± 0.2 s-1 vs. 1.4 ± 0.2 s-1; all P < 0.05). Multivariable linear regression demonstrated that hyperlipidemia was independently associated with circumferential PDSR (β = - 0.477, P < 0.05) in obesity after controlling for growth differences, other cardiovascular risk factors, and central fat distribution. In addition, android fat had an independently negative relationship with longitudinal and radial PS (β = - 0.486 and β = - 0.408, respectively; all P < 0.05); and visceral fat was negatively associated with longitudinal PDSR (β = - 0.563, P < 0.05). Differently, gynoid fat was positively correlated with circumferential PS and PDSR and radial PDSR (β = 0.490, β = 0.481, and β = 0.413, respectively; all P < 0.05).
CONCLUSIONS: Hyperlipidemia is independently associated with subclinical LV diastolic dysfunction in obesity. Central fat distribution (android and visceral fat) has a negative association, while peripheral fat distribution (gynoid fat) has a positive association on subclinical LV function. These results suggest that appropriate management of hyperlipidemia may be beneficial for obese patients, and that the differentiation of fat distribution in different regions may facilitate the precise management of obese patients. Clinical trials registration Effect of lifestyle intervention on metabolism of obese patients based on smart phone software (ChiCTR1900026476).