切换至 "中华医学电子期刊资源库"

中华心脏与心律电子杂志 ›› 2025, Vol. 13 ›› Issue (03) : 140 -148. doi: 10.3877/cma.j.issn.2095-6568.2025.03.003

指南解读

《2024年ESC肥胖与心血管疾病临床共识》解读
陈公渊, 黄周青()   
  1. 325000 温州医科大学附属第一医院心血管内科
  • 收稿日期:2025-01-26 出版日期:2025-09-25
  • 通信作者: 黄周青

Interpretation of the 2024 ESC clinical consensus on obesity and cardiovascular disease

Gongyuan Chen, Zhouqing Huang()   

  1. Department of Cardiovascular Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
  • Received:2025-01-26 Published:2025-09-25
  • Corresponding author: Zhouqing Huang
引用本文:

陈公渊, 黄周青. 《2024年ESC肥胖与心血管疾病临床共识》解读[J/OL]. 中华心脏与心律电子杂志, 2025, 13(03): 140-148.

Gongyuan Chen, Zhouqing Huang. Interpretation of the 2024 ESC clinical consensus on obesity and cardiovascular disease[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2025, 13(03): 140-148.

肥胖是心血管疾病的关键风险因素,给诊疗带来了诸多挑战。欧洲心脏病学会(ESC)发布的《肥胖与心血管疾病:ESC临床共识声明》(以下简称“该共识”),为肥胖与心血管疾病的临床关联以及肥胖管理提供了最新的证据和临床建议,具有重要的指导意义。该共识内容丰富,涵盖了肥胖的定义、流行病学、病因、表型及评估,肥胖对心血管疾病危险因素的影响,肥胖对不同心血管疾病的影响及病理生理机制,现阶段肥胖的干预策略等诸多方面。该共识不仅剖析了肥胖与心血管疾病的复杂关系,还强调了肥胖预防和干预的重要性,尤其是在心血管疾病的发生、治疗及预后管理中的作用。本文旨在对该共识进行简要而精准的解读,以期为临床医生在肥胖患者相应心血管疾病的管理中提供有价值的参考,助力提升肥胖相关心血管疾病的诊疗水平,改善患者的预后。

表1 世界卫生组织关于成人超重和肥胖的分类标准
图1 评估脂肪组织主要成像方法的优缺点PVAT为心外膜周围脂肪,EAT为心外膜脂肪厚度,PAT为心包脂肪组织,IMA为内乳动脉,PET为正电子发射型计算机断层显像
图2 冠状动脉心外膜脂肪组织对冠状动脉粥样硬化的影响JNK为应激活化蛋白激酶,NF-κB为核因子激活的B细胞的-轻链增强,TLR为Toll样受体,SPLA-Ⅱ为分泌型磷脂酶A2,FABP4为脂肪酸结合蛋白4,AGE-RAGE为高级糖基化终末产物-受体,GLUT-4为分泌泡囊对葡萄糖转运子蛋白4,CCL2为趋化因子2,IL-6为白细胞介素6,TNF为肿瘤坏死因子
图3 常见的饮食干预策略
表2 6种用于体重管理药物的主要不良反应和禁忌证
图4 主要的内镜和外科体重管理干预措施BMI为体重指数
[1]
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults[J]. Lancet, 2024, 403(10431):1027-1050.
[2]
Koskinas KC, Van Craenenbroeck EM, Antoniades C, et al. Obesity and cardiovascular disease: an ESC clinical consensus statement[J]. Eur Heart J, 2024, 45(38):4063-4098.
[3]
Expert Consultation WHO. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies[J]. Lancet, 2004, 363(9403):157-163.
[4]
Timmis A, Vardas P, Townsend N, et al. European Society of Cardiology: cardiovascular disease statistics 2021[J]. Eur Heart J, 2022, 43(8):716-799.
[5]
GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years[J]. N Engl J Med, 2017, 377(1):13-27.
[6]
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet, 2014, 384(9945):766-781.
[7]
Geserick M, Vogel M, Gausche R, et al. Acceleration of BMI in early childhood and risk of sustained obesity[J]. N Engl J Med, 2018, 379(14):1303-1312.
[8]
Katsoulis M, Lai AG, Diaz-Ordaz K, et al. Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records[J]. Lancet Diabetes Endocrinol, 2021, 9(10):681-694.
[9]
Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years[J]. N Engl J Med, 2007, 357(4):370-379.
[10]
Katzmarzyk PT, Pérusse L, Rao DC, et al. Familial risk of overweight and obesity in the Canadian population using the WHO/NIH criteria[J]. Obes Res, 2000, 8(2):194-197.
[11]
Blüher M. Obesity: global epidemiology and pathogenesis[J]. Nat Rev Endocrinol, 2019, 15(5):288-298.
[12]
Emerging Risk Factors Collaboration, Wormser D, Kaptoge S, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies[J]. Lancet, 2011, 377(9771):1085-1095.
[13]
Wiklund P, Toss F, Weinehall L, et al. Abdominal and gynoid fat mass are associated with cardiovascular risk factors in men and women[J]. J Clin Endocrinol Metab, 2008, 93(11):4360-4366.
[14]
Britton KA, Fox CS. Ectopic fat depots and cardiovascular disease[J]. Circulation, 2011, 124(24):e837-e841.
[15]
Visseren F, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice[J]. Eur Heart J, 2021, 42(34):3227-3337.
[16]
Oikonomou EK, Williams MC, Kotanidis CP, et al. A novel machine learning-derived radiotranscriptomic signature of perivascular fat improves cardiac risk prediction using coronary CT angiography[J]. Eur Heart J, 2019, 40(43):3529-3543.
[17]
Frija-Masson J, Mullaert J, Vidal-Petiot E, et al. Accuracy of smart scales on weight and body composition: observational study[J]. JMIR Mhealth Uhealth, 2021, 9(4):e22487.
[18]
Antoniades C, Tousoulis D, Vavlukis M, et al. Perivascular adipose tissue as a source of therapeutic targets and clinical biomarkers[J]. Eur Heart J, 2023, 44(38):3827-3844.
[19]
Iacobellis G. Epicardial adipose tissue in contemporary cardiology[J]. Nat Rev Cardiol, 2022, 19(9):593-606.
[20]
Polkinghorne MD, West HW, Antoniades C. Adipose tissue in cardiovascular disease: from basic science to clinical translation[J]. Annu Rev Physiol, 2024, 86:175-198.
[21]
Marx N, Federici M, Schütt K, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes[J]. Eur Heart J, 2023, 44(39):4043-4140.
[22]
Cameron NA, Petito LC, McCabe M, et al. Quantifying the sex-race/ethnicity-specific burden of obesity on incident diabetes mellitus in the United States, 2001 to 2016: MESA and NHANES[J]. J Am Heart Assoc, 2021, 10(4):e018799.
[23]
Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial[J]. Lancet, 2018, 391(10120):541-551.
[24]
Tchernof A, Després JP. Pathophysiology of human visceral obesity: an update[J]. Physiol Rev, 2013, 93(1):359-404.
[25]
Wildman RP, Mackey RH, Bostom A, et al. Measures of obesity are associated with vascular stiffness in young and older adults[J]. Hypertension, 2003, 42(4):468-473.
[26]
Hall JE. The kidney, hypertension, and obesity[J]. Hypertension, 2003, 41(3 Pt 2):625-33.
[27]
Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II[J]. Ann Intern Med, 2001, 134(1):1-11.
[28]
Després JP. Cardiovascular disease under the influence of excess visceral fat[J]. Crit Pathw Cardiol, 2007, 6(2):51-59.
[29]
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk[J]. Eur Heart J, 2020, 41(1):111-188.
[30]
Hasan B, Nayfeh T, Alzuabi M, et al. Weight loss and serum lipids in overweight and obese adults: a systematic review and meta-Analysis[J]. J Clin Endocrinol Metab, 2020, 105(12):dgaa673.
[31]
Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing[J]. J Am Coll Cardiol, 2008, 52(8):686-717.
[32]
Chirinos JA, Gurubhagavatula I, Teff K, et al. CPAP, weight loss, or both for obstructive sleep apnea[J]. N Engl J Med, 2014, 370(24):2265-2275.
[33]
Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis[J]. BMC Public Health, 2009, 9:88.
[34]
Battineni G, Sagaro GG, Chintalapudi N, et al. Impact of obesity-induced inflammation on cardiovascular diseases (CVD)[J]. Int J Mol Sci, 2021, 22(9):4798.
[35]
Kenchaiah S, Evans JC, Levy D, et al. Obesity and the risk of heart failure[J]. N Engl J Med, 2002, 347(5):305-313.
[36]
Pandey A, LaMonte M, Klein L, et al. Relationship between physical activity, body mass index, and risk of heart failure[J]. J Am Coll Cardiol, 2017, 69(9):1129-1142.
[37]
黄峻. 中国心力衰竭流行病学特点和防治策略[J/OL]. 中华心脏与心律电子杂志, 2015 (2): 2-3.
[38]
Elkholey K, Papadimitriou L, Butler J, et al. Effect of obesity on response to spironolactone in patients with heart failure with preserved ejection fraction[J]. Am J Cardiol, 2021, 146:36-47.
[39]
Croteau D, Qin F, Chambers JM, et al. Differential effects of sacubitril/valsartan on diastolic function in mice with obesity-related metabolic heart disease[J]. JACC Basic Transl Sci, 2020, 5(9):916-927.
[40]
Nalliah CJ, Sanders P, Kottkamp H, et al. The role of obesity in atrial fibrillation[J]. Eur Heart J, 2016, 37(20):1565-1572.
[41]
Van Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)[J]. Eur Heart J, 2024, 45(36):3314-3414.
[42]
Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism[J]. J Thromb Thrombolysis, 2016, 41(1):3-14.
[43]
Ageno W, Becattini C, Brighton T, et al. Cardiovascular risk factors and venous thromboembolism: a meta-analysis[J]. Circulation, 2008, 117(1):93-102.
[44]
Kushnir M, Choi Y, Eisenberg R, et al. Efficacy and safety of direct oral factor Xa inhibitors compared with warfarin in patients with morbid obesity: a single-centre, retrospective analysis of chart data[J]. Lancet Haematol, 2019, 6(7):e359-e365.
[45]
Perino AC, Fan J, Schmitt S, et al. Anticoagulation treatment and outcomes of venous thromboembolism by weight and body mass index: insights from the veterans health administration[J]. Circ Cardiovasc Qual Outcomes, 2021, 14(11):e008005.
[46]
Larsson SC, Wolk A, Håkansson N, et al. Overall and abdominal obesity and incident aortic valve stenosis: two prospective cohort studies[J]. Eur Heart J, 2017, 38(28):2192-2197.
[47]
Collaboration GBM, Di Angelantonio E, ShN B, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents[J]. Lancet, 2016, 388(10046):776-786.
[48]
Teramoto M, Yamagishi K, Cui R, et al. Body mass index and mortality from nonrheumatic aortic valve disease among Japanese men and women[J]. J Atheroscler Thromb, 2023, 30(2):150-159.
[49]
Patel E, Varghese JJ, Garg M, et al. Comparison of body mass index (four categories) to in-hospital outcomes in patients who underwent transcatheter aortic valve implantation[J]. Am J Cardiol, 2023, 192:190-195.
[50]
McInerney A, Tirado-Conte G, Rodes-Cabau J, et al. Impact of morbid obesity and obesity phenotype on outcomes after transcatheter aortic valve replacement[J]. J Am Heart Assoc, 2021, 10(12):e019051.
[51]
曾庆春, 许顶立. 钙化性主动脉瓣狭窄患者的心力衰竭治疗[J/OL]. 中华心脏与心律电子杂志, 2022, 10(3): 156.
[52]
Blüher M, Aras M, Aronne LJ, et al. New insights into the treatment of obesity[J]. Diabetes Obes Metab, 2023, 25(8):2058-2072.
[53]
Lugones-Sanchez C, Sanchez-Calavera MA, Repiso-Gento I, et al. Effectiveness of an mHealth intervention combining a smartphone App and smart band on body composition in an overweight and obese population: randomized controlled trial (EVIDENT 3 study)[J]. JMIR Mhealth Uhealth, 2020, 8(11):e21771.
[54]
Elmaleh-Sachs A, Schwartz JL, Bramante CT, et al. Obesity management in adults: a review[J]. JAMA, 2023, 330(20):2000-2015.
[55]
Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? a harmonised meta-analysis of data from more than 1 million men and women[J]. Lancet, 2016, 388(10051):1302-1310.
[56]
Oppert JM, Bellicha A, van Baak MA, et al. Exercise training in the management of overweight and obesity in adults: synthesis of the evidence and recommendations from the European Association for the Study of Obesity Physical Activity Working Group[J]. Obes Rev, 2021, 22(Suppl 4):e13273.
[57]
Ge L, Sadeghirad B, Ball G, et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials[J]. BMJ, 2020, 369:m696.
[58]
Jay M, Gillespie C, Schlair S, et al. Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight? [J] BMC Health Serv Res, 2010, 10:159.
[59]
Wharton S, Lau D, Vallis M, et al. Obesity in adults: a clinical practice guideline[J]. CMAJ, 2020, 192(31):E875-E891.
[60]
Müller TD, Blüher M, Tschöp MH, et al. Anti-obesity drug discovery: advances and challenges[J]. Nat Rev Drug Discov, 2022, 21(3):201-223.
[61]
Chakhtoura M, Haber R, Ghezzawi M, et al. Pharmacotherapy of obesity: an update on the available medications and drugs under investigation[J]. EClinicalMedicine, 2023, 58:101882.
[62]
Sattar N, Lee M, Kristensen SL, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials[J]. Lancet Diabetes Endocrinol, 2021, 9(10):653-662.
[63]
Coskun T, Sloop KW, Loghin C, et al. LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus: From discovery to clinical proof of concept[J]. Mol Metab, 2018, 18:3-14.
[64]
Frías JP, Davies MJ, Rosenstock J, et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes[J]. N Engl J Med, 2021, 385(6):503-515.
[65]
Cherla A, Renwick M, Stefanini G, et al. Cost-effectiveness of cardiovascular, obesity, and diabetes mellitus drugs: comparative analysis of the United States and England[J]. J Am Heart Assoc, 2020, 9(21):e018281.
[66]
Sharaiha RZ, Shikora S, White KP, et al. Summarizing consensus guidelines on obesity management: a joint, multidisciplinary venture of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and World Gastroenterology Organisation (WGO)[J]. J Clin Gastroenterol, 2023, 57(10):967-976.
[67]
Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial[J]. Lancet, 2022, 400(10350):441-451.
[68]
van Veldhuisen SL, Gorter TM, van Woerden G, et al. Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis[J]. Eur Heart J, 2022, 43(20):1955-1969.
[69]
Carlsson L, Sjöholm K, Jacobson P, et al. Life expectancy after bariatric surgery in the Swedish obese subjects study[J]. N Engl J Med, 2020, 383(16):1535-1543.
[1] 《乳腺癌新辅助免疫治疗专家共识》专家组. 乳腺癌新辅助免疫治疗专家共识(2025年版)[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(04): 193-197.
[2] 中国妇幼保健协会儿童变态反应专业委员会, 《儿童皮肤创面诊疗专家共识(2025版)》编写组. 儿童皮肤创面诊疗专家共识(2025版)[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(05): 374-383.
[3] 《生长因子在Ⅱ度烧伤创面治疗中应用专家共识(2024版)》编写组. 生长因子在Ⅱ度烧伤创面治疗中应用专家共识(2024版)[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(04): 277-283.
[4] 中国研究型医院学会机器人与腹腔镜外科专业委员会, 《中华消化外科杂志》编辑委员会. 完全单孔腹腔镜胃癌手术操作专家共识(2025版)[J/OL]. 中华普通外科学文献(电子版), 2025, 19(04): 217-224.
[5] 陈斌雄, 谢铭. 袖状胃切除术与胃旁路术对肥胖合并T2DM的治疗效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 461-466.
[6] 中国康复医学会特殊环境作业损伤防治与康复专业委员会. 高原低压低氧环境下骨关节炎相关慢性继发性肌肉骨骼疼痛管理专家共识[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(05): 665-672.
[7] 中华医学会妇产科分会妇科内镜学组. 机器人辅助单孔妇科手术中国专家共识(2025年版)[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(04): 193-197.
[8] 中国医师协会结直肠肿瘤专业委员会术中放疗协作组. 结直肠癌术中放疗专家共识(2025版)[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(04): 299-306.
[9] 中国医师协会结直肠肿瘤专业委员会. 结直肠癌卵巢转移诊疗专家共识(2025版)[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(04): 307-318.
[10] 乔晞. 肥胖相关性肾脏疾病的治疗[J/OL]. 中华肾病研究电子杂志, 2025, 14(05): 300-300.
[11] 世界华人神经外科协会颅脑创伤专业委员会, 颅骨缺损修补术专家共识协作组. 颅骨缺损修补术专家共识(2025版)[J/OL]. 中华神经创伤外科电子杂志, 2025, 11(04): 210-219.
[12] 薛家明, 陈帅, 焦宇文, 王冬梅, 赵杰, 周艳, 汤黎明. 内镜技术在减重治疗中的现状与未来[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(05): 421-425.
[13] 樊子君, 王怡婷, 胡端敏, 任怡琳, 盛颖玥, 刘天浩, 吴铁龙, 戴圆圆, 薛育政. 内镜下胃壁注射A型肉毒毒素减重的研究现状[J/OL]. 中华临床医师杂志(电子版), 2025, 19(06): 467-470.
[14] 王玲洁, 王瑷萍, 李朝军, 丁跃有, 杨德业, 赵清, 崔兆强, 王京昆, 王宏宇. 心脏和血管健康技术创新研发策略专家共识(2024第一次报告,上海)[J/OL]. 中华临床医师杂志(电子版), 2025, 19(05): 323-336.
[15] 王美, 赵勇, 张健, 张俐娜, 丁健华, 曹煜. 基于CT测量肾周脂肪面积对Lap-ISR吻合口并发症的预测价值[J/OL]. 中华临床医师杂志(电子版), 2025, 19(05): 367-373.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?