Arterburn David, Schauer Daniel P, Wise Ruth E, Gersin Keith S, Fischer David R, Selwyn Calvin A, Erisman Anne, Tsevat Joel
Group Health Center for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.
Department of Medicine, University of Washington, Seattle, WA, USA.
Obes Surg. 2009 Feb;19(2):184-189. doi: 10.1007/s11695-008-9534-7. Epub 2008 Aug 13.
Bariatric surgery is being conducted more often for morbid obesity, but little evidence exists about how it affects the risk of future cardiovascular events. The goal of this study was to quantify the change in predicted 10-year cardiovascular risk following laparoscopic Roux-en-Y gastric bypass (LRYGBP).
We conducted a prospective clinical study of morbidly obese adults undergoing LRYGBP at a university hospital in the USA. Our primary outcome measure was mean change in 10-year cardiovascular risk at 12 months. We estimated cardiovascular risk by using the Framingham risk equation, which calculates the absolute risk of cardiovascular events for patients with no known history of heart disease, stroke, or peripheral vascular disease by using information on age, sex, blood pressure, total and high-density lipoprotein cholesterol levels, smoking status, and history of diabetes.
Ninety-two participants underwent LRYGBP between December 2004 and October 2005. Their predicted baseline 10-year cardiovascular risk was 6.7%. At 6 and 12 months, their predicted risk had decreased to 5.2% and 5.4%, respectively. Assuming no change in risk among untreated patients, this represents an absolute risk reduction of 1.3%; which suggests that 77 morbidly obese patients would have to undergo LRYGBP to avert one new case of cardiovascular disease over the ensuing 10 years (number needed to treat = 77).
Our findings indicate that LRYGBP is associated with improvements in cardiovascular risk factors and a corresponding decrease in predicted 10-year risk of cardiovascular disease.
减肥手术越来越多地用于治疗病态肥胖，但关于其如何影响未来心血管事件风险的证据很少。本研究的目的是量化腹腔镜Roux-en-Y胃旁路术（LRYGBP）后预测的10年心血管风险变化。
我们在美国一家大学医院对接受LRYGBP的病态肥胖成年人进行了一项前瞻性临床研究。我们的主要结局指标是12个月时10年心血管风险的平均变化。我们使用弗雷明汉风险方程估算心血管风险，该方程通过使用年龄、性别、血压、总胆固醇和高密度脂蛋白胆固醇水平、吸烟状况以及糖尿病病史等信息，计算无已知心脏病、中风或外周血管疾病病史患者发生心血管事件的绝对风险。
2004年12月至2005年10月期间，92名参与者接受了LRYGBP。他们预测的基线10年心血管风险为6.7%。在6个月和12个月时，他们预测的风险分别降至5.2%和5.4%。假设未治疗患者的风险无变化，这代表绝对风险降低了1.3%；这表明77名病态肥胖患者必须接受LRYGBP才能在接下来的10年中避免一例新的心血管疾病（治疗所需人数=77）。
我们的研究结果表明，LRYGBP与心血管危险因素的改善以及预测的10年心血管疾病风险相应降低有关。
