Priester Tiffany, Ault Travis G, Davidson Lance, Gress Richard, Adams Ted D, Hunt Steven C, Litwin Sheldon E
Cardiology Division, University of Utah, Salt Lake City, UT, USA.
Obes Surg. 2015 Jan;25(1):90-6. doi: 10.1007/s11695-014-1327-6.
Obesity is associated with elevated coronary artery calcium (CAC), a marker of coronary atherosclerosis that is strongly predictive of cardiovascular events. We evaluated the effects of marked weight loss achieved through Roux-en-Y gastric bypass surgery (GBS) on CAC scores.
We performed echocardiography and computed tomography of the heart in 149 subjects 6 years after enrollment in a prospective registry evaluating the cardiovascular effects of GBS. Coronary calcium scores, left ventricular ejection fraction, and left ventricular mass were measured.
At baseline, most coronary risk factors were similar between the GBS and nonsurgical groups including current smoking, systolic blood pressure, LDL-C, HDL-C, and TG. However, GBS patients were younger (4.7 years), less likely to be diabetic, and less likely to be postmenopausal. At 6 years after enrollment, CAC score was significantly lower in patients who underwent GBS than those without surgery (p < 0.01). GBS subjects had a lower likelihood of having measureable coronary calcium (odds ratio of CAC > 0 = 0.39; 95 % CI of (0.17, 0.90)). Significant predictors of 0 CAC were GBS, female gender, younger age, baseline BMI, and baseline LDL-C. Substituting change in BMI for group status as a predictor variable showed that BMI change also predicted CAC (p = 0.045). Changes in LDL-C did not predict the CAC differences between groups (p = 0.67).
Sustained weight loss achieved through bariatric surgery is associated with less coronary calcification. This effect, which appears to be independent of changes in LDL-C, may contribute to lower cardiac mortality in patients with successful GBS.
肥胖与冠状动脉钙化（CAC）增加有关，冠状动脉钙化是冠状动脉粥样硬化的一个标志物，能强有力地预测心血管事件。我们评估了通过Roux-en-Y胃旁路手术（GBS）实现的显著体重减轻对CAC评分的影响。
在一项评估GBS心血管效应的前瞻性登记研究中，我们对149名受试者入组6年后进行了超声心动图和心脏计算机断层扫描。测量了冠状动脉钙化评分、左心室射血分数和左心室质量。
在基线时，GBS组和非手术组之间的大多数冠状动脉危险因素相似，包括当前吸烟、收缩压、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯。然而，GBS患者更年轻（4.7岁），患糖尿病的可能性更小，绝经后状态的可能性更小。入组6年后，接受GBS手术的患者的CAC评分显著低于未手术的患者（p < 0.01）。GBS受试者出现可测量冠状动脉钙化的可能性更低（CAC>0的比值比=0.39；95%置信区间为（0.17，0.90））。0 CAC的显著预测因素是GBS、女性、年龄较小、基线BMI和基线低密度脂蛋白胆固醇。用BMI变化替代组状态作为预测变量表明，BMI变化也可预测CAC（p = 0.045）。低密度脂蛋白胆固醇的变化不能预测两组之间的CAC差异（p = 0.67）。
通过减肥手术实现的持续体重减轻与较少的冠状动脉钙化有关。这种效应似乎独立于低密度脂蛋白胆固醇的变化，可能有助于降低GBS手术成功患者的心脏死亡率。
