Эктопическое ожирение у пациентов без клинически значимых сердечно-сосудистых заболеваний: ориентировочные нормативы, частота и клинические характеристики
Эктопическое ожирение у пациентов без клинически значимых сердечно-сосудистых заболеваний: ориентировочные нормативы, частота и клинические характеристики
Podzolkov VI, Bragina AЕ, Osadchiy КК, Rodionova YuN, Djafarova ZB, Khalenyan MH, Dishkaya SO. Ectopic obesity in patients without manifested cardiovascular disease: regulations, frequency and clinical characteristics. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(9):1072–1077. DOI: 10.26442/00403660.2022.09.201847
Эктопическое ожирение у пациентов без клинически значимых сердечно-сосудистых заболеваний: ориентировочные нормативы, частота и клинические характеристики
Цель. Изучение частоты, распределения и характеристики эктопического ожирения у пациентов без клинически значимых сердечно- сосудистых заболеваний. Материалы и методы. В исследование включены 320 пациентов без клинически значимых сердечно-сосудистых заболеваний (средний возраст 63,8±13,9 года), 38 из них – без сердечно-сосудистых факторов риска (условно здоровые). Всем пациентам проведена оценка антропометрических данных, степени и типа ожирения, показателей липидного спектра. Всем пациентам выполнялась компьютерная томография грудной клетки с расчетом объемов периваскулярной жировой ткани (ПВЖТ) и перикардиальной жировой ткани (ПКЖТ) с использованием специализированного программного обеспечения Tissue Composition Module QCTPro (Mindways Software, США). Объемы ПКЖТ и ПВЖТ, превышающих 90-й процентиль в группе здоровых лиц, рассматривали как эктопическое ожирение. Статистическую обработку полученных результатов проводили с использованием статистического пакета программ Statistica 10. Результаты. Объем ПКЖТ≥3,2 см3 и объем ПВЖТ≥0,4 см3 считали критериями перикардиального и периваскулярного ожирения. У 81 (25,2%) пациента выявлено изолированное эктопическое ожирение, у 85 (26,5%) – изолированное абдоминальное ожирение. Перикардиальное ожирение имели 146 (42,9%) человек, периваскулярное – 134 (39,4%). Частота эктопического ожирения у пациентов с артериальной гипертензией (АГ) статистически значимо выше по сравнению с лицами без АГ. Достоверно чаще эктопические формы ожирения выявлялись у лиц с избыточной массой тела и при ожирении. Кроме того, наличие перикардиального и периваскулярного ожирения выявлено у пациентов с избыточной и даже нормальной массой тела. При сопоставлении клинических характеристик пациентов с изолированным абдоминальным и изолированным эктопическим ожирением метаболические показатели, а также частота АГ и дислипидемии достоверно не отличались. Заключение. Эктопическое ожирение может развиваться вне глобального ожирения. Кроме того, данный тип ожирения сопровождается метаболическими нарушениями и АГ независимо от абдоминального распределения жировой ткани.
Aim. To determine the frequency, distribution and characteristics of ectopic obesity in patients without manifested cardiovascular disease. Materials and methods. We examined 320 patients without manifested cardiovascular disease (average age 63.8±13.9 years), 38 of them – without cardiovascular risk factors (healthy referent group). Anthropometric indicators were measured, body mass index (BMI) was calculated. Degree, type of obesity, lipid profile were evaluated. All patients underwent multi-detector chest computed tomography in spiral mode on Toshiba Aquilion Prime scanner using standardized protocol. Perivascular adipose tissue (PVAT) and pericardial adipose tissue (PAT) were detected using specialized semi-automatic software Tissue Composition Module QCTPro (Mindways Software, Inc., USA) after scanner calibration with special phantom. PAT and PVAT exceeding the 90th percentile in the healthy referent group were considered as ectopic obesity. Statistical analysis was performed using Statistica 10.0 software (StatSoft Inc., USA). Results. PAT volume ≥3.2 cm3 and PVAT volume ≥0.4 cm3 were criteria for high pericardial and high perivascular fat; 81 (25.2%) patients had ectopic obesity, 85 (26.5%) patients – abdominal obesity; 146 (42.9%) people had high pericardial fat, 134 (39.4%) – high perivascular fat. The frequency of ectopic obesity in patients with arterial hypertension (AH) was statistically significantly higher compared to persons without AH. Significantly more often ectopic forms of obesity were detected in patients with overweight and obesity. The high pericardial fat and high perivascular fat were found in patients with overweight and normal body weight. When comparing the clinical characteristics of patients with abdominal and ectopic obesity, metabolic parameters, as well as the incidence of hypertension and dyslipidemia, did not differ significantly. Conclusion. Ectopic obesity can develop outside of global obesity. In addition, this type of obesity is accompanied by metabolic disorders and AH, regardless of the abdominal distribution of adipose tissue.
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1. GBD 2015 Obesity Guidelines. Health effect of overweight and obesity in 195 countries over 25 years. N Eng J Med. 2017;177:13-27. DOI:10.1056/NEJMoa1614362
2. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2021;42(34):3227-337. DOI:10.1093/eurheartj/ehab484
3. Neeland IJ, Ross R, Després J-P, et al. Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement. Lancet Diabetes Endocrinol. 2019;7(9):715-25. DOI:10.1016/S2213-8587(19)30084-1
4. Talman AH, Psaltis PJ, Cameron JD, et al. Epicardial adipose tissue: far more than a fat depot. Cardiovasc Diagn Ther. 2014;4(6):416-29. DOI:10.3978/j.issn.2223-3652.2014.11.05
5. Azimova MO, Blinova NV, Zhernakova YuV, Chazova IE. Obesity as a predictor for cardiovascular disease development: role of localized fat depot. Sistemnye gipertenzii. 2018;15(3):39-43 (in Russian). DOI:10.26442/2075-082X_2018.3.39-43
6. Bragina AE, Tarzimanova AI, Osadchiy KK, et al. Relationship of Pericardial Fat Tissue With Cardiovascular Risk Factors in Patients Without Cardiovascular Diseases. Metab Syndr Relat Disord. 2021;19(9):524‑30. DOI:10.1089/met.2021.0045
7. Ueda Y, Shiga Y, Idemoto Y, et al. Association Between the Presence or Severity of Coronary Artery Disease and Pericardial Fat, Paracardial Fat, Epicardial Fat, Visceral Fat, and Subcutaneous Fat as Assessed by Multi-Detector Row Computed Tomography. Int Heart J. 2018;59:695-704. DOI:10.1536/ihj.17-234
8. Homsi R, Kuetting D, Sprinkart A, et al. Interrelations of Epicardial Fat Volume, Left Ventricular T1-Relaxation Times and Myocardial Strain in Hypertensive Patients: A Cardiac Magnetic Resonance Study. J Thorac Imaging. 2017;32(3):169-75. DOI:10.1097/RTI.0000000000000264
9. Rosito GA, Massaro JM, Hoffmann U, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the Framingham Heart Study. Circulation. 2008;117(5):605-13. DOI:10.1161/CIRCULATIONAHA.107.743062
10. Druzhilov MA, Kuznetsova TYu. Internal obesity as a risk factor for arterial hypertension. Rossiiskii kardiologicheskii zhurnal. 2019;4:7-12 (in Russian).
DOI:10.15829/1560-4071-2019-4-7-12
11. Podzolkov VI, Tarzimanova AI, Bragina AE, et al. Role of epicardial adipose tissue in the development of atrial fibrillation in hypertensive patients. Kardiovaskulyarnaya terapiya i profilaktika. 2020;19(6):2707 (in Russian). DOI:10.15829/1728-8800-2020-2707
12. Podzolkov VI, Bragina AE, Osadchiy KK, et al. Relationship between the volume of perivascular adipose tissue and the vascular wall lesion. Kardiovaskulyarnaya terapiya i profilaktika. 2021;20(7):2993 (in Russian). DOI:10.15829/1728-8800-2021-2993
13. Britton KA, Wang N, Palmisano J, et al. Thoracic periaortic and visceral adipose tissue and their cross-sectional associations with measures of vascular function. Obesity (Silver Spring). 2013;21(7):1496-503. DOI:10.1002/oby.20166
14. Queiroz M, Sena CM. Perivascular adipose tissue in age-related vascular disease. Ageing Research Reviews. 2020;59:101040. DOI:10.1016/j.arr.2020.101040
15. Thanassoulis G, Massaro JM, Hoffmann U, et al. Prevalence, distribution, and risk factor correlates of high pericardial and intrathoracic fat depots in the Framingham heart study. Circ Cardiovasc Imaging. 2010;3:559‑66. DOI:10.1161/CIRCIMAGING.110.956706
16. Lehman SJ, Massaro JM, Schlett CL, et al. Peri-aortic fat, cardiovascular disease risk factors, and aortic calcification: the Framingham Heart Study. Atherosclerosis. 2010;210(2):656-61. DOI:10.1016/j.atherosclerosis.2010.01.007
17. Jeong JW, Jeong MH, Yun KH, et al. Echocardiographic epicardial fat thickness and coronary artery disease. Circ J. 2007;71(4):536-9. DOI:10.1253/circj.71.536
18. Diagnosis, treatment, prevention of obesity and associated diseases. National clinical guidelines. Russian Society of Cardiology. Russian Scientific Medical Society of Therapists. antihypertensive league. Association of Clinical Pharmacologists. 2017:3-164 (in Russian).
19. Kobalava ZD, Konradi AO, Nedogoda SV, et al. Arterial hypertension in adults. Clinical guidelines 2020. Rossiiskii kardiologicheskii zhurnal. 2020;25(3):3786 (in Russian). DOI:10.15829/1560-4071-2020-3-3786
20. Mach F, Baigent C, Catapano A, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardio vascular risk. Eur Heart J. 2020;41(1):111-88. DOI:10.1093/eurheartj/ehz455
21. Podzolkov VI. Arterial'naia gipertenziia. Moscow: MIA, 2016 (in Russian).
22. Rabkin SW. The relationship between epicardial fat and indices of obesity and the metabolic syndrome: a systematic review and meta-analysis. Metab Syndr Relat Disord. 2014;12(1):31-42. DOI:10.1089/met.2013.0107
23. Wu Y, Zhang A, Hamilton DJ, Deng T. Epicardial fat in the maintenance of cardiovascular health. Methodist Debakey Cardiovasc J. 2017;13:20-4. DOI:10.14797/mdcj-13-1-20
24. Wang TD, Lee WJ, Shih FY, et al. Relations of epicardial adipose tissue measured by multidetector computed tomography to components of the metabolic syndrome are region-specific and independent of anthropometric indexes and intraabdominal visceral fat. J Clin Endocrinol Metab. 2009;94:662-9. DOI:10.1210/jc.2008-0834
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*anna.bragina@mail.ru
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Valery I. Podzolkov, Anna Е. Bragina*, Konstantin К. Osadchiy, Yulia N. Rodionova, Zarema B. Djafarova, Milena H. Khalenyan, Selen O. Dishkaya
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*anna.bragina@mail.ru