Long-term cardiovascular risk and coronary events in morbidly obese patients treated with laparoscopic gastric banding
Long-term cardiovascular risk and coronary events in morbidly obese patients treated with laparoscopic gastric banding
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DOI：
10.1016/j.soard.2013.03.010
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发表时间：
2014-01-01
影响因子：
3.1
通讯作者：
Favretti, Franco
中科院分区：
文献类型：
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作者：
Busetto, Luca;De Stefano, Fabio;Favretti, Franco
背景：报道减肥手术对心血管危险因素和事件影响的长期研究很少。本研究的目的是分析接受减肥手术治疗的病态肥胖患者的多种心血管危险因素和冠状动脉事件发生率的降低，并进行10年的随访。方法：这是一项前瞻性无对照研究，采用腹腔镜可调节胃束带。心血管危险因素（空腹血糖、总胆固醇、HDL-C、甘油三酯、血压）已在手术时和术后12-18个月对650例腹腔镜可调节胃束带患者进行了测定。2010年再次确定心血管危险状况，并收集长期随访（10年）期间冠状动脉事件发生率。结果：共纳入318例患者（男58例，女260例）。手术年龄为38.6±10.4岁。体重指数为46.7±7.2 kg/m(2)。随访时间为12.7±1.5年。12-18个月时体重减轻17.6% +/- 15.7%，12.7年时体重减轻17.1% +/- 14.8%。在短期评估中观察到血糖、总胆固醇、甘油三酯、收缩压和舒张压的显著降低，并在长期评估中得到证实。12-18个月时HDL-C不变，12.7年时显著升高。在长期随访中记录了5例冠状动脉事件（1.6%）。观察到的事件率与根据前瞻性心血管明斯特研究（PROCAM）评分计算的基线10年心肌梗死概率预计的事件率进行比较。观察率（1.6%）略低于预期率（2.0% +/- 4.9%）。结论：在腹腔镜下可调节胃束带术后10年，病态肥胖患者体重稳定下降，心血管风险显著改善。(C) 2014年美国代谢与减肥外科学会。版权所有。
Background: Long-term studies reporting the effects of bariatric surgery on cardiovascular risk factors and events are scarce. The aim of this study was to analyze reduction of multiple cardiovascular risk factors and rates of coronary events in morbidly obese patients treated with bariatrie surgery and with > 10 years of follow-up.Methods: This was a prospective uncontrolled study with laparoscopic adjustable gastric banding. Cardiovascular risk factors (fasting glucose, total cholesterol, HDL-C, triglycerides, blood pressure) have been previously determined both at surgery and 12-18 months after in 650 patients treated with laparoscopic adjustable gastric banding from 1993 to 1999. Cardiovascular risk status was again determined in 2010, and the rate of coronary events during long-term ( > 10 years) follow-up was collected.Results: A total of 318 patients (58 men and 260 women) were retrieved. Age at surgery was 38.6 +/- 10.4 years. Body mass index was 46.7 +/- 7.2 kg/m(2). Follow-up was 12.7 +/- 1.5 years. Weight loss was 17.6% +/- 15.7% of baseline weight at 12-18 months and 17.1% +/- 14.8% at 12.7 years. A significant reduction in blood glucose, total cholesterol, triglycerides, and systolic and diastolic blood pressure was observed at the short-term evaluation and confirmed in the long term. HDL-C was unchanged at 12-18 months and significantly increased at 12.7 years. Five coronary events (1.6%) were recorded during long-term follow-up. The rate of observed events was compared with the rate of events expected according to baseline 10-year probability of myocardial infarction calculated with the Prospective Cardiovascular Munster study (PROCAM) score. Observed rate (1.6%) was slightly lower than the expected rate (2.0% +/- 4.9%).Conclusions: Stable weight loss and significant improvement of cardiovascular risk profile were observed in morbidly obese patients 10 years after laparoscopic adjustable gastric banding. (C) 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.