Department of Molecular and Clinical Medicine and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Diabetes Care. 2012 Dec;35(12):2613-7. doi: 10.2337/dc12-0193. Epub 2012 Aug 1.
Obese individuals with type 2 diabetes have an increased risk of cardiovascular disease. The effect of bariatric surgery on cardiovascular events in obese individuals with type 2 diabetes remains to be determined. The Swedish Obese Subjects (SOS) study is a prospective, controlled intervention study that examines the effects of bariatric surgery on hard end points. The aim of the present study was to examine the effect of bariatric surgery on cardiovascular events in the SOS study participants with type 2 diabetes.
All SOS study participants with type 2 diabetes at baseline were included in the analyses (n = 345 in the surgery group and n = 262 in the control group). Mean follow-up was 13.3 years (interquartile range 10.2-16.4) for all cardiovascular events.
Bariatric surgery was associated with a reduced myocardial infarction incidence (38 events among the 345 subjects in the surgery group vs. 43 events among the 262 subjects in the control group; log-rank P = 0.017; adjusted hazard ratio [HR] 0.56 [95% CI 0.34-0.93]; P = 0.025). No effect of bariatric surgery was observed on stroke incidence (34 events among the 345 subjects in the surgery group vs. 24 events among the 262 subjects in the control group; log-rank P = 0.852; adjusted HR 0.73 [0.41-1.30]; P = 0.29). The effect of surgery in reducing myocardial infarction incidence was stronger in individuals with higher serum total cholesterol and triglycerides at baseline (interaction P value = 0.02 for both traits). BMI (interaction P value = 0.12) was not related to the surgery outcome.
Bariatric surgery reduces the incidence of myocardial infarction in obese individuals with type 2 diabetes. Preoperative BMI should be integrated with metabolic parameters to maximize the benefits of bariatric surgery.
患有 2 型糖尿病的肥胖个体患心血管疾病的风险增加。减重手术对患有 2 型糖尿病的肥胖个体心血管事件的影响仍有待确定。瑞典肥胖受试者（SOS）研究是一项前瞻性、对照干预研究，旨在研究减重手术对硬终点的影响。本研究的目的是检验 SOS 研究中接受减重手术的 2 型糖尿病患者的心血管事件的影响。
所有基线时患有 2 型糖尿病的 SOS 研究参与者均纳入分析（手术组 345 例，对照组 262 例）。所有心血管事件的中位随访时间为 13.3 年（四分位间距 10.2-16.4）。
减重手术与心肌梗死发生率降低相关（手术组 345 例患者中有 38 例发生心肌梗死，对照组 262 例患者中有 43 例发生心肌梗死；对数秩检验 P = 0.017；校正后的风险比[HR]0.56[95%CI 0.34-0.93]；P = 0.025）。减重手术对卒中发生率没有影响（手术组 345 例患者中有 34 例发生卒中，对照组 262 例患者中有 24 例发生卒中；对数秩检验 P = 0.852；校正后的 HR 0.73[0.41-1.30]；P = 0.29）。在基线时血清总胆固醇和甘油三酯水平较高的个体中，手术降低心肌梗死发生率的效果更强（两种特征的交互 P 值均为 0.02）。BMI（交互 P 值 = 0.12）与手术结果无关。
减重手术可降低 2 型糖尿病肥胖个体的心肌梗死发生率。术前 BMI 应与代谢参数相结合，以最大限度地提高减重手术的获益。
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