Mor Alessandro, Omotosho Philip, Torquati Alfonso
Department of Surgery, Duke Center for Metabolic and Bariatric Surgery, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA.
Surg Endosc. 2014 Oct;28(10):2815-20. doi: 10.1007/s00464-014-3550-6. Epub 2014 May 23.
Roux-en-Y gastric bypass (RYGB) reduces most of the obesity-related comorbidities known to increase the cardiovascular risk in obese subjects. The Framingham risk score (FRS) is designed to be independent of body weight and estimates the 10-year risk for coronary heart disease (CHD), myocardial infarction, stroke, cardiovascular disease (CVD), death from CHD, and death from CVD. Our aim was to evaluate the effectiveness of RYGB on improving the FRS when compared to a matched control group who underwent diabetes support and education program (DSE).
In a prospective cohort study, we evaluated preoperatively and at 12 months, 61 morbidly obese subjects with diabetes. Thirty underwent laparoscopic RYGB, and 31 received 1 year of DSE, consisting of educational sessions on diet, nutrition, and exercise. Groups were matched for gender, age, weight, blood pressure, and cholesterol and triglyceride levels. Strict gender-specific FRS was used to assess the cardiovascular risk.
Excess weight-loss percentages (%EWL) were 55.6 ± 15.1 in the RYGB group and 1.2 ± 10.8 in the DSE group (P < 0.001). The two groups were matched for baseline FRS. RYGB patients experienced a significant decrease in all FRS, whereas control subjects did not show a significant decrease for the 10-year risk for CHD, CVD and death from CVD. The between-group differences for changes from baseline to 12 months in all FRS were significant. The 10-year risk reductions for CHD, MI, stroke, CVD, death from CHD, and death from CVD in the RYGB group relative to the DSE group were, respectively, 42, 48, 30, 39, 50, and 50%. No correlations between reduction in FRS and %EWL were found after RYGB.
A significant improvement in the 10 year estimated cardiovascular risk is observed in patients undergoing RYGB, but not in those who were offered usual medical therapy plus DSE. However, the effects of RYGB on FRS are independent of weight loss.
Roux-en-Y胃旁路术（RYGB）可降低大多数已知会增加肥胖受试者心血管风险的肥胖相关合并症。弗雷明汉风险评分（FRS）旨在独立于体重，并估计冠心病（CHD）、心肌梗死、中风、心血管疾病（CVD）、CHD死亡和CVD死亡的10年风险。我们的目的是评估与接受糖尿病支持和教育计划（DSE）的匹配对照组相比，RYGB对改善FRS的有效性。
在一项前瞻性队列研究中，我们对61例患有糖尿病的病态肥胖受试者进行术前及术后12个月的评估。30例接受腹腔镜RYGB手术，31例接受为期1年的DSE，包括饮食、营养和运动方面的教育课程。两组在性别、年龄、体重、血压以及胆固醇和甘油三酯水平方面进行匹配。采用严格的性别特异性FRS来评估心血管风险。
RYGB组的超重减轻百分比（%EWL）为55.6±15.1，DSE组为1.2±10.8（P<0.001）。两组的基线FRS相匹配。RYGB患者的所有FRS均显著降低，而对照组在CHD、CVD和CVD死亡的10年风险方面未显示出显著降低。所有FRS从基线到12个月的组间变化差异显著。RYGB组相对于DSE组，CHD、心肌梗死、中风、CVD、CHD死亡和CVD死亡的10年风险降低分别为42%、48%、30%、39%、50%和50%。RYGB术后未发现FRS降低与%EWL之间存在相关性。
接受RYGB手术的患者10年估计心血管风险有显著改善，但接受常规药物治疗加DSE的患者则不然。然而，RYGB对FRS的影响独立于体重减轻。
Zotero 插件