Background: The rising rates of obesity, along with its associated morbidities, represent an important global health threat. Atherosclerotic cardiovascular disease (ASCVD) is among the most common and hazardous obesity-related morbidity, and it is especially prevalent among those who suffer from type 2 diabetes (T2DM). Bariatric surgery (BS) is known to help with effective weight management and reduce the burden of cardiovascular risk factors, especially T2DM.
Methods: A nested propensity-matched cohort study was carried out using the Clinical Practice Research Datalink. The cohort included 1186 patients with no past history of ASCVD, 593 of whom underwent BS and 593 propensity-score matched controls, followed up for a mean of 42.7 months. The primary end point was the incidence of new ASCVD; defined as new coronary artery disease (CAD), cerebrovascular disease (CeVD), peripheral arterial disease (PAD), or miscellaneous atherosclerotic disease; secondary end points included primary end point components alone and all-cause mortality.
Results: Patients who underwent BS had significantly lower rates of new ASCVD (hazard ratio [HR] 0.53, confidence interval [CI] 0.30-0.95, P = 0.032. There were no significant differences in rates of CAD, CeVD, and PAD individually across cohorts, but a lower rate of all-cause mortality was observed in the BS cohort (HR 0.36, CI 0.19-0.71, P = 0.003).
Conclusions: BS was associated with improved ASCVD outcomes and lower mortality in patients with obesity and T2DM. This study provides evidence for increased awareness of potential benefits of BS in the management of obesity by highlighting a potential role in primary prevention for ASCVD.
背景: 肥胖率的上升及其相关的疾病是一个严重的全球健康威胁。动脉粥样硬化性心血管疾病(ASCVD)是肥胖相关疾病中最常见、危害最大的疾病之一, 在2型糖尿病(T2DM)患者中尤为常见。众所周知, 减肥手术(BS)有助于有效的体重管理和减轻心血管危险因素的负担, 特别是T2DM。 方法: 使用临床实践研究数据链接进行倾向匹配队列研究。队列包括1186名过去没有ASCVD病史的患者, 其中593人接受了BS治疗, 另外593人作为倾向性评分匹配的对照组, 平均随访时间为42.7个月。主要终点是新发ASCVD的发生率；新发ASCVD定义为新发冠状动脉疾病(CAD)、脑血管病(CEVD)、外周动脉疾病(PAD)或其他动脉粥样硬化疾病；次要终点包括单独的主要终点成分和全因死亡率。 结果: 接受BS治疗的患者新发ASCVD发生率显著降低(危险比[HR]0.53, 可信区间[CI]0.3-0.95, P=0.032)。各队列间冠心病、脑血管病和PAD的发病率无显著差异, 但BS组全因死亡率较低(HR0.36, CI 0.19-0.71, P=0.003)。 结论: 在肥胖和2型糖尿病患者中, BS与改善ASCVD预后和降低死亡率有关。这项研究通过强调BS在ASCVD一级预防中的潜在作用, 为提高人们对BS在肥胖管理中潜在益处的认识提供了证据。.
Keywords: atherosclerotic cardiovascular disease; bariatric surgery; diabetes; obesity; 减肥手术; 动脉粥样硬化性心血管疾病; 糖尿病; 肥胖.
© 2020 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.