Treatment of Obesity: Weight Loss and Bariatric Surgery.
Treatment of Obesity: Weight Loss and Bariatric Surgery.
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DOI：
10.1161/circresaha.116.307591
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发表时间：
2016-05-27
影响因子：
20.1
通讯作者：
Eckel RH
中科院分区：
文献类型：
--
作者：
Wolfe BM;Kvach E;Eckel RH
这篇综述的重点是减肥手术在减少心血管疾病（CVD）中的潜在机制和适应症，以及这种干预的其他预期益处。以减肥为目的的减肥手术的基本基础是确定严重肥胖是一种与多种健康不良影响相关的疾病，对于无法通过非手术手段维持体重减轻的患者，可以通过成功减肥来逆转或改善这种疾病。本文对减肥手术的可能适应症以及具体的减肥手术程序进行了解释，并对此类手术的安全性文献进行了回顾。侵入性较小或涉及较少胃肠道重排的手术减轻的体重要少得多，但围手术期和长期风险要低得多。体重减轻的最终好处与合并症的减少、生活质量和全因死亡率有关。由于体重减轻是减肥手术改善心血管疾病风险的潜在理由，目前的循证研究涉及体脂分布、血脂异常、高血压、糖尿病、炎症、阻塞性睡眠呼吸暂停等。讨论了减肥手术减少心血管疾病事件的基本原理，并将其与对全因死亡率的影响并列。考虑到体重减轻后与肥胖相关的心血管疾病危险因素的改善，我们有理由期待肥胖人群体重减轻后心血管疾病事件和相关死亡率的降低。回顾了当前证据的质量，并说明了未来的研究机会和总结。
This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD) as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by non-surgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the co-morbidities, quality of life and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes, inflammation, obstructive sleep apnea and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors following weight loss, it is reasonable to expect a reduction of CVD events and related mortality following weight loss in populations with obesity. The quality of the current evidence is reviewed and future research opportunities and summaries are stated.