Vogel Jody A, Franklin Barry A, Zalesin Kerstyn C, Trivax Justin E, Krause Kevin R, Chengelis David L, McCullough Peter A
Department of Medicine, Division of Cardiology, Royal Oak, Michigan, USA.
Am J Cardiol. 2007 Jan 15;99(2):222-6. doi: 10.1016/j.amjcard.2006.08.017. Epub 2006 Nov 16.
In recent years, bariatric surgery has become an increasingly used therapeutic option for morbid obesity. The effect of weight loss after bariatric surgery on the predicted risk of coronary heart disease (CHD) has not previously been studied. We evaluated baseline (preoperative) and follow-up (postoperative) body mass index, CHD risk factors, and Framingham risk scores (FRSs) for 109 consecutive patients with morbid obesity who lost weight after laparoscopic Roux-en-Y gastric bypass surgery. Charts were abstracted using a case-report form by a reviewer blinded to the FRS results. The study included 82 women (75%) and 27 men (25%) (mean age 46 +/- 10 years). Mean body mass index values at baseline and follow-up were 49 +/- 8 and 36 +/- 8 kg/m(2), respectively (p <0.0001). During an average follow-up of 17 months, diabetes, hypertension, and dyslipidemia resolved or improved after weight loss. Thus, the risks of CHD as predicted by FRS decreased by 39% in men and 25% in women. The predicted 10-year CHD risks at baseline and follow-up were 6 +/- 5% and 4 +/- 3%, respectively (p < or =0.0001). For those without CHD, men compared favorably with the age-matched general population, with a final 10-year risk of 5 +/- 4% versus an expected risk of 11 +/- 6% (p <0.0001). Likewise, women achieved a level below the age-adjusted expected 10-year risk of the general population, with a final risk of 3 +/- 3% versus 6 +/- 4% (p <0.0001). In conclusion, weight loss results in a significant decrease in FRS 10-year predicted CHD risk. Bariatric surgery decreases CHD risk to rates lower than the age- and gender-adjusted estimates for the general population. These data suggest substantial and sustained weight loss after bariatric surgery may be a powerful intervention to decrease future rates of myocardial infarction and death in the morbidly obese.
近年来，减肥手术已成为治疗病态肥胖越来越常用的方法。减肥手术后体重减轻对冠心病（CHD）预测风险的影响此前尚未得到研究。我们评估了109例连续接受腹腔镜Roux-en-Y胃旁路手术后体重减轻的病态肥胖患者的基线（术前）和随访（术后）体重指数、冠心病危险因素及弗雷明汉风险评分（FRS）。由一位对FRS结果不知情的审阅者使用病例报告表提取病历信息。该研究纳入了82名女性（75%）和27名男性（25%）（平均年龄46±10岁）。基线和随访时的平均体重指数值分别为49±8和36±8kg/m²（p<0.0001）。在平均17个月的随访期间，糖尿病、高血压和血脂异常在体重减轻后得到缓解或改善。因此，FRS预测的男性冠心病风险降低了39%，女性降低了25%。基线和随访时预测的10年冠心病风险分别为6±5%和4±3%（p≤0.0001）。对于那些没有冠心病的患者，男性与年龄匹配的普通人群相比情况较好，最终10年风险为5±4%，而预期风险为11±6%（p<0.0001）。同样，女性的风险水平低于年龄调整后的普通人群预期10年风险，最终风险为3±3%，而预期风险为6±4%（p<0.
