Sanchis Pilar, Frances Carla, Nicolau Joana, Rivera Rosmeri, Fortuny Regina, Julian Xavier, Pascual Salvador, Gomez Luis A, Rodriguez Irene, Olivares Josefina, Ayala Luisa, Masmiquel Luis
Endocrinology and Nutrition Department, Hospital Son Llàtzer, University Institute of Health Sciences Research (IUNICS), Health Research Institute of Palma (IdISPa), Palma de Mallorca, Spain,
Obes Surg. 2015 Jan;25(1):97-108. doi: 10.1007/s11695-014-1321-z.
The aim was to compare obesity-related cardiovascular (CV) risk factors (classic and emerging) and the estimated CV risk at 10 years (calculated by REGICOR) in obese Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention at baseline and after 1 year of follow-up.
Patients submitted to bariatric surgery (n = 108) and standardized program of therapeutic changes in lifestyle (n = 90) were retrospectively included. Clinical history, physical examination, and laboratory analysis were routinely determined before weight loss intervention and at 1 year follow-up.
Seventy-five percent of the surgery patients had a CV risk lower than 5 % and not one patient had a 10-year CV risk higher than 15 %. The percentage of patients with comorbidities (diabetes and sleep apnea syndrome) was higher in the surgery group. Seventeen of the surgery patients had no comorbidities. The improvement in CV risk profile was significant higher in the surgery group. CV risk benefit of both intervention groups was related to baseline higher CV risk, with type 2 diabetes with poor metabolic control and high cholesterol levels being the most important predictors for surgery patients. Neither body mass index nor excess of weight loss was related to CV risk improvement.
Mediterranean patients undergoing a weight loss intervention have a low CV risk. In comparison with lifestyle intervention, surgery induces a better improvement of CV risk. This benefit is related to estimated CV risk, presence of diabetes, and cholesterol levels at baseline. These observations should be taken into account in order to optimize health resources.
目的是比较肥胖的地中海地区患者在基线时以及随访1年后接受减肥手术和强化生活方式干预后，与肥胖相关的心血管（CV）危险因素（经典和新出现的）以及10年估计心血管风险（由REGICOR计算）。
回顾性纳入接受减肥手术的患者（n = 108）和标准化生活方式治疗改变计划的患者（n = 90）。在体重减轻干预前和随访1年时常规确定临床病史、体格检查和实验室分析。
75%的手术患者心血管风险低于5%，没有一名患者的10年心血管风险高于15%。手术组合并症（糖尿病和睡眠呼吸暂停综合征）患者的百分比更高。17名手术患者没有合并症。手术组心血管风险状况的改善明显更高。两个干预组的心血管风险获益均与基线时较高的心血管风险相关，代谢控制不佳的2型糖尿病和高胆固醇水平是手术患者最重要的预测因素。体重指数和体重减轻过多均与心血管风险改善无关。
接受体重减轻干预的地中海地区患者心血管风险较低。与生活方式干预相比，手术能更好地改善心血管风险。这种获益与估计的心血管风险、糖尿病的存在以及基线时的胆固醇水平有关。为了优化卫生资源，应考虑这些观察结果。
