Gero Daniel, Favre Lucie, Allemann Pierre, Fournier Pierre, Demartines Nicolas, Suter Michel
Department of Visceral Surgery, University Hospital (CHUV), Lausanne, Switzerland.
Division of Endocrinology, Diabetology and Metabolism, University Hospital (CHUV), Lausanne, Switzerland.
Obes Surg. 2018 Mar;28(3):805-811. doi: 10.1007/s11695-017-2938-5.
Dyslipidemia is a known risk factor for cardiovascular (CV) events. The aim of the study was to assess lipid profiles and their impact on CV risk changes in a large patient cohort 5 years after Roux-en-Y gastric bypass (RYGB).
All patients who underwent primary RYGB for severe obesity in our two hospitals between January 1999 and December 2009 were included. The Framingham risk score was used.
One thousand and forty-eight patients were included, 791 women and 257 men. Five-year complete lipid profile was available for 77% of patients. At 5 years, mean body mass index (BMI) decreased from 45.7 ± 6 to 31 ± 5.8 kg/m (p < 0.001), excess BMI loss (EBMIL) was 72.35 ± 22%, and total body weight loss (TWL) 31.5 ± 9%. Lipid values improved significantly. Total- and LDL-cholesterol levels dropped at 1 year from 5.4 to 4.48 mmol/L and 3.2 to 2.41 mmol/L, respectively, and slightly increased thereafter. Triglyceride levels dropped from 2 to 1.17 mmol/L at 1 year and remained unchanged. HDL levels rose continuously from 1.27 to 1.77 mmol/L at 5 years. Lipid profile improved more in patients with greater weight loss (%EBMIL ≥ 50 or %TWL ≥ 25%). Assuming that all patients were non-smokers and other baseline risk factors (hypertension, diabetes) remained unchanged at 5 years, the amelioration of the lipid profile itself yielded to a 27% reduction of CV risk (p < 0.001).
RYGB results in sustained excess weight loss and in amelioration of the lipid profile from the first to fifth postoperative year. This improvement translates into significantly lower CV risk from the first year after surgery.
血脂异常是已知的心血管（CV）事件风险因素。本研究的目的是评估在接受Roux-en-Y胃旁路术（RYGB）5年后的一大组患者队列中的血脂谱及其对CV风险变化的影响。
纳入1999年1月至2009年12月期间在我们两家医院因严重肥胖接受初次RYGB手术的所有患者。采用弗雷明汉风险评分。
共纳入1048例患者，其中女性791例，男性257例。77%的患者有5年的完整血脂谱数据。5年后，平均体重指数（BMI）从45.7±6降至31±5.8kg/m²（p<0.001），超重体重指数降低（EBMIL）为72.35±22%，总体重减轻（TWL）为31.5±9%。血脂值显著改善。总胆固醇和低密度脂蛋白胆固醇水平在术后1年分别从5.4降至4.48mmol/L和从3.2降至2.41mmol/L，此后略有上升。甘油三酯水平在术后1年从2降至1.17mmol/L并保持不变。高密度脂蛋白水平在5年中从1.27持续升至1.77mmol/L。体重减轻更多（%EBMIL≥50或%TWL≥25%）的患者血脂谱改善更明显。假设所有患者均为非吸烟者且其他基线风险因素（高血压、糖尿病）在5年时保持不变，血脂谱本身的改善使CV风险降低了27%（p<0.001）。
RYGB导致持续的超重减轻以及从术后第1年到第5年血脂谱的改善。这种改善转化为术后第1年起显著降低的CV风险。
