體重與心臟病：減重如何降低心血管風險

體重與心臟病：體重過重對心臟健康的影響

如果您對體重與冠狀動脈心臟病之間的關聯感興趣，您來對地方了。深入了解肥胖與心血管風險、高血壓與體重，以及如何透過維持健康體重來改善心臟健康。

減輕體重，守護心臟

Heart disease is the leading cause of death in the United States. One person dies every 37 seconds from it, and 50% of men and 64% of women who die have no prior symptoms. And weight and heart disease are connected—overweight and obesity can put you at a higher risk of heart disease.

But how can an unhealthy weight damage your heart and lead to heart failure?

Fortunately, it may be possible to prevent or treat heart failure through lifestyle modifications.

"Even people of normal weight can damage their heart if they gain weight over time."

Source: Ian Neeland M.D., Journal of the American Heart Association, July 2019

心臟問題與體重有何關聯？

Weight and cardiovascular issues are strongly connected. For example, there is a strong link between obesity and hypertension, which can lead to heart failure, atrial fibrillation, coronary heart disease, and other dangerous conditions—and losing extra pounds may help to lower your blood pressure.

The Framingham Heart Study, a long-term study on cardiovascular health begun in 1948, has established that cardiac health can be influenced by lifestyle and environmental factors.

The study showed that 78% of hypertension cases in men and 65% in women are directly related to obesity, and high blood pressure and high cholesterol are major risk factors for cardiovascular disease.

體重過重與高血壓

脂肪組織可能增加血管阻力。根據 ObesityAction.org："體重增加 10 至 22 磅的女性與體重增加超過 55 磅的女性，其高血壓的相對風險分別為 1.7 和 5.2。"

體重過重與心房顫動

心房顫動（AFib）是一種公共衛生問題，其中心臟的電活動受到干擾。體重過重也會對心臟主要泵血腔室內部造成壓力，這可能增加發生心房顫動等心律不整的風險。

體重過重與心臟瓣膜病

美國心臟病學會表示：「體脂肪增加可透過心房擴大、心室擴大及動脈粥樣硬化等途徑導致心臟病。」

體重過重與心臟衰竭

在心臟衰竭的情況下，心肌不再能夠向全身泵送足夠的血液。"肥胖 20 年後，心臟衰竭的盛行率增加 70%；肥胖 30 年後，盛行率上升 90%"。

What exactly is heart failure?

Heart failure, also known as congestive heart failure, is a chronic condition in which the heart doesn’t pump blood as well as it should. The heart may become enlarged or pump faster to compensate, causing fatigue and breathing problems.

Complications from heart failure are serious and may include liver or kidney damage, arrhythmias, and heart valve problems. You may also gain weight during heart failure due to fluid accumulation.

How are heart failure and weight connected?

Carrying excess fat, especially around the abdomen, has been linked to heart disease. But did you know that the excess weight itself can damage your heart? Johns Hopkins researchers have proven that the weight itself can cause injury to your heart muscle.

In a study published in the Journal of the American College of Cardiology: Heart Failure, the authors reported that those who were the most obese and had the highest levels of troponin, an enzyme released by injured heart muscle cells, were nine times more likely to develop heart failure than those of normal weight with undetectable troponin levels.

In another study, researchers found that people who gained even a little weight—even as little as 5 percent—were more likely to experience a thickening of the left side of the heart, which may indicate heart failure.

Other experts have pointed to the relationship between weight and the risk of cardiovascular disease. For example, the European Society of Cardiology says:

“As body mass index and fat mass increase, so does the risk of aortic valve stenosis,”

Aortic Stenosis is a form of valvular heart disease that may lead to heart failure.

The upshot? Even a little excess weight can have a big impact on your heart—and your cardiovascular health.

減重後您的心臟會發生什麼變化？

Even small changes can make a big difference. In a 2016 study in Translational Behavioral Medicine, researchers found that patients who lost even 5–10% of their body weight showed significant reductions in triglycerides, total cholesterol, and LDL cholesterol.

"Five to 10% weight losses produced improvements in cardiovascular risk factors, but greater weight losses were associated with even greater improvement."

And in an article in Progress in Cardiovascular Diseases, the authors note, “Intentional weight loss, accomplished through behavioral weight loss and exercise, improves insulin sensitivity and associated cardio-metabolic risk factors such as lipid measures, blood pressure, measures of inflammation and vascular function both in healthy individuals and patients with coronary heart disease. Additionally, physical fitness, physical function and quality of life all improve.”

The takeaway? Moderate weight loss can have a big impact on the heart.

有助於預防心血管疾病的最佳體重是多少？

The short answer: It’s complicated. While some body fat is essential, too much of it may increase your risk of cardiovascular disease.

Many experts suggest aiming for a body mass index (BMI) within the healthy weight range: between 18.5 and 24.9 for an adult 20 years of age or older. But you should know that BMI doesn’t tell the whole story: other factors, such as age and gender, also play a role in weight. Knowing your body composition may give you a more complete picture of your health.

A side note: Some researchers believe that prevention efforts should focus less on BMI and more on underlying societal and environmental causes of obesity. In an article published in The BMJ, the authors write:

“Although the health hazards of obesity have been clearly established, exactly where healthy weight ends and unhealthy weight begins is a matter of controversy.”

One thing we do know: as we mentioned earlier, location matters. Excess abdominal or visceral fat-—the fat that wraps around your organs—can be dangerous, increasing insulin resistance and other cardiovascular risk factors. In a report in Circulation entitled “Body Fat Distribution and Risk of Cardiovascular Disease: An Update,” the author notes, “On the other hand, visceral adipose tissue and liver fat may be key drivers of plasma markers of the cardiometabolic risk profile, such as insulin resistance, glucose intolerance, [and] inflammation.”

So if you’re gaining weight, keep an eye on where you’re gaining it, and consider tracking your body composition to see a more complete picture. If you have concerns, ask your doctor.

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How to watch your weight

If you’re overweight or obese, weight loss may seem daunting. But we have some suggestions that might help.

Know your numbers

Knowing your BMI, blood pressure, blood sugar, and cholesterol and monitoring them regularly can help you to stay on track, and alert your doctor if you see something you’re concerned about.

Know your symptoms

Knowing your numbers is important, but it’s also good to keep an eye on your symptoms. For example, symptoms of hypertension include shortness of breath, an irregular heartbeat, chest pains, headaches, nausea, and dizziness. Symptoms of heart disease in women may be a little different. If you experience anything new or unusual, it might be a good idea to check in with your doctor.

Make small, sustainable changes

Even a little weight loss can help to improve your health, and setting a realistic weight loss goal can help. Many experts suggest aiming for 1 to 2 pounds per week—which may not sound like much, but can really add up over time. If it’s easier, you may wish to set a process goal instead—for example, walking 7,000–10,000 steps per day. In short, set a weight goal for a healthy heart.

In addition, watch out for yo-yo dieting. In a large-scale study, researchers from the Catholic University of Korea found that erratic weight gain and loss increased the risk of cardiac events.

In the study, researchers found that people whose weight, blood pressure, cholesterol, and blood sugar levels fluctuated were 127 percent more likely to die.
They were also 43 percent more likely to have a heart attack and 41 percent more likely to have a stroke. So, instead of aiming for drastic weight changes, it’s better to look for easy lifestyle alterations that you can stick to.

Need ideas? Check out tips from the American Heart Association, including easy food substitutions to help you feel satisfied.

Keep moving

Whether you’re trying to reach an optimal weight, maintain a healthy weight, or achieve moderate weight loss, staying active is really important.

In a Withings study, we found that users who logged 4,000 steps or fewer had an average systolic blood pressure of 127, versus 123 for those logging at least 12,000 steps a day. We also found that sedentary users also logged an average heart rate 7% higher than more active users.

結語

在體重與心血管疾病方面，您可以採取許多措施來降低體重過重的風險並改善心臟健康。如果您擔心體重與心臟衰竭的風險，有一些步驟或許能幫助您加以控制。了解自己的各項數值、理解減重對心臟的影響、考慮減重或預防體重增加，最重要的是，請諮詢您的醫生。