ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet12367ometendo-12367Research ArticleНаучные обзорыReviewsТипы ожирения и их влияние на отдаленные исходы у больных с сердечно-сосудистыми заболеваниямиTypes of obesity and their impact on long-term outcomes in patients with cardiovascular diseasehttps://orcid.org/0000-0002-1009-099XМиклишанскаяС. В.MiklishanskayaS. V.

Миклишанская Софья Владимировна - кандидат медицинских наук; Researcher ID: AAJ-6522-2020; Scopus Author ID: 55672897400; eLibrary SPIN: 2843-1855

121552, Москва, ул. 3-я Черепковская, д. 15а

Sofia V. Miklishanskaya, MD, PhD; Researcher ID: AAJ-6522-2020; Scopus Author ID: 55672897400; eLibrary SPIN: 2843-1855

3rd Cherepkovskaya 15A, 121552 Moscow

kvant83@list.ruhttps://orcid.org/0000-0003-0984-1562МазурН. А.MazurN. A.

Мазур Николай Алексеевич - доктор медицинских наук, профессор; Scopus Author ID: 56383512500; eLibrary SPIN: 2391-0976.

Москва

Nikolaу A. Mazur, MD, PhD, Professor; Scopus Author ID: 56383512500; eLibrary SPIN: 2391-0976

Moscow

kvant83@list.ruРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation202123072021182125131Copyright © Миклишанская С.В., Мазур Н.А., 20212021Миклишанская С.В., Мазур Н.А.Miklishanskaya S.V., Mazur N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/12367

Крупные проспективные исследования, включающие от нескольких сотен тысяч до нескольких миллионов человек из общей популяции, показали, что у лиц с ожирением общая смертность выше, чем у людей с нормальным индексом массы тела (ИМТ). ­Использование ИМТ в предсказании прогноза у лиц с сердечно-сосудистыми заболеваниями приводило к выявлению обратной взаимосвязи между ИМТ и риском смерти. Ожирение, определяемое по ИМТ, оказывается весьма гетерогенным при определении прогноза в разных группах больных. Использование визуализирующей техники при обследовании позволило установить, что плохие последствия для здоровья сопряжены с накоплением висцеральной жировой ткани. Новые данные также свидетельствуют о том, что эктопическое отложение жира (в печени, в эпикарде) может способствовать повышению риска развития атеросклероза, сердечно-сосудистых заболеваний и сахарного диабета 2 типа. Количество исследований, изучавших непосредственное влияние висцеральной жировой ткани на смертность, очень ограничено. Их результаты крайне противоречивы, основаны не на проспективных наблюдениях, а на построении статистических моделей. Жировая ткань рассматривается в настоящее время как эндокринный и паракринный орган. Отложение жировой ткани во внутренних органах, помимо метаболических нарушений, вероятно, приводит к формированию также местных неблагоприятных воздействий. Вышеприведенные данные подводят нас к заключению о необходимости создания новой классификации, которая позволила бы улучшить стратификацию риска развития сердечно-сосудистых заболеваний и смерти у лиц с ожирением.

Large prospective studies involving several hundred thousands to several million people from the general population have shown that people with obesity have a higher overall mortality rate than people with a normal BMI. The use of BMI in predicting the prognosis of people with cardiovascular disease has led to the inverse relationship between BMI and risk of death. Obesity, determined by BMI, is very heterogeneous in determining prognosis in different groups of patients. The use of imaging techniques during the examination revealed that poor health effects are associated with the accumulation of visceral adipose tissue. New evidence also suggests that ectopic deposition of fat (in the liver, in the epicardium) may increase the risk of developing atherosclerosis and cardiovascular disease and type 2 diabetes. The number of studies examining the direct effect of visceral adipose tissue on mortality is very limited. Their results are extremely contradictory, based not on prospective observations, but on the construction of statistical models. Adipose tissue is currently considered as an endocrine and paracrine organ. Deposition of adipose tissue in the internal organs, in addition to metabolic disorders), probably leads to the formation of local adverse effects. The above data lead us to the conclusion that it is necessary to create a new classification that would improve the stratification of the risk of developing cardiovascular disease and death in people with obesity.

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The authors declare that there are no conflicts of interest present.