Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure.
Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure.
复制标题
DOI：
10.1161/jaha.116.005126
复制
发表时间：
2017-05-23
影响因子：
5.4
通讯作者：
Hirsch AG
中科院分区：
文献类型：
--
作者：
Benotti PN;Wood GC;Carey DJ;Mehra VC;Mirshahi T;Lent MR;Petrick AT;Still C;Gerhard GS;Hirsch AG
肥胖及其与预期寿命缩短的关系已得到充分证实，心血管疾病是死亡的主要原因之一。代谢手术是治疗严重肥胖症的一种强有力的干预措施，可改善合并症和心血管危险因素。本研究调查了代谢手术与长期心血管事件之间的关系。Roux‐en‐Y胃旁路手术（RYGB）患者队列在年龄、体重指数、性别、Fragrance风险评分、吸烟史、降压药物使用、糖尿病状态和日历年方面与同期非手术对照患者队列紧密匹配。主要心血管事件（心肌梗死、卒中和充血性心力衰竭）的主要研究终点采用考克斯回归进行评价。使用重复测量回归评估纵向心血管危险因素的次要终点。RYGB和匹配的对照组（每个队列N=1724）在手术后随访长达12年（总体中位数为6.3年）。Kaplan-Meier分析显示，RYGB队列的主要复合心血管事件（P=0.017）和充血性心力衰竭（0.0077）发生率在统计学上显著降低。校正的考克斯回归模型证实了RYGB队列中重度复合心血管事件的减少（风险比=0.58，95% CI=0.42-0.82）。术后在RYGB队列中观察到心血管风险因素（例如，10年心血管风险评分、总胆固醇、高密度脂蛋白、收缩压和糖尿病）的改善。胃旁路手术与降低主要心血管事件和充血性心力衰竭的风险相关。
Obesity and its association with reduced life expectancy are well established, with cardiovascular disease as one of the major causes of fatality. Metabolic surgery is a powerful intervention for severe obesity, resulting in improvement in comorbid diseases and in cardiovascular risk factors. This study investigates the relationship between metabolic surgery and long‐term cardiovascular events. A cohort of Roux‐en‐Y gastric bypass surgery (RYGB) patients was tightly matched by age, body mass index, sex, Framingham Risk Score, smoking history, use of antihypertension medication, diabetes mellitus status, and calendar year with a concurrent cohort of nonoperated control patients. The primary study end points of major cardiovascular events (myocardial infarction, stroke, and congestive heart failure) were evaluated using Cox regression. Secondary end points of longitudinal cardiovascular risk factors were evaluated using repeated‐measures regression. The RYGB and matched controls (N=1724 in each cohort) were followed for up to 12 years after surgery (overall median of 6.3 years). Kaplan–Meier analysis revealed a statistically significant reduction in incident major composite cardiovascular events (P=0.017) and congestive heart failure (0.0077) for the RYGB cohort. Adjusted Cox regression models confirmed the reductions in severe composite cardiovascular events in the RYGB cohort (hazard ratio=0.58, 95% CI=0.42–0.82). Improvements of cardiovascular risk factors (eg, 10‐year cardiovascular risk score, total cholesterol, high‐density lipoprotein, systolic blood pressure, and diabetes mellitus) were observed within the RYGB cohort after surgery. Gastric bypass is associated with a reduced risk of major cardiovascular events and the development of congestive heart failure.