Division of Cardiology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, PH3-342, New York, NY, USA.
Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
Cardiovasc Res. 2019 Mar 15;115(4):800-806. doi: 10.1093/cvr/cvy266.
Studies have suggested relationships between obesity and cardiovascular disease (CVD) morbidity. However, little is known about whether substantial weight reduction affects the risk of CVD-related acute care use in obese patients with CVD. The objective of this study was to determine whether bariatric surgery is associated with decreased risk of CVD-related acute care use.
We performed a self-controlled case series study of obese adults with CVD who underwent bariatric surgery, using population-based emergency department (ED), and inpatient samples in California, Florida, and Nebraska from 2005 to 2011. The primary outcome was ED visit or unplanned hospitalization for CVD. We used conditional logistic regression to compare the risk during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. We identified 11 106 obese adults with CVD who underwent bariatric surgery. During the reference period, 20.6% [95% confidence interval (CI), 19.8-21.3%] of patients had an ED visit or unplanned hospitalization for CVD. The risk did not significantly change in the subsequent 12-month pre-surgery period [adjusted odds ratio (aOR) 0.98; 95% CI, 0.93-1.04; P = 0.42]. By contrast, in the first 12-month period after bariatric surgery, the risk significantly decreased (aOR 0.91; 95% CI, 0.86-0.96; P = 0.002). The risk remained reduced in the subsequent 13-24 months post-bariatric surgery (aOR 0.84; 95% CI, 0.79-0.89; P < 0.001). There was no reduction in the risk in separate obese populations that underwent non-bariatric surgery (i.e. cholecystectomy, hysterectomy). By CVD category, the risk of acute care use for coronary artery disease (CAD), heart failure (HF), and hypertension decreased after bariatric surgery, whereas that of dysrhythmia and venous thromboembolism transiently increased (Bonferroni corrected P < 0.05 for all comparisons).
Bariatric surgery is associated with a lower risk of overall CVD-related ED visit or unplanned hospitalization. The decline was mainly driven by reduced risk of acute care use for CAD, HF, and hypertension after bariatric surgery.
已有研究提示肥胖与心血管疾病（CVD）发病率之间存在关联。然而，人们对于体重显著减轻是否会降低肥胖合并 CVD 患者的 CVD 相关急性治疗使用率知之甚少。本研究旨在明确减重手术是否与降低 CVD 相关急性治疗使用率相关。
本研究采用基于人群的病例系列自我对照研究，纳入 2005 年至 2011 年加利福尼亚州、佛罗里达州和内布拉斯加州因肥胖合并 CVD 而接受减重手术的成年人，利用急诊部（ED）和住院患者样本。主要结局为 CVD 相关 ED 就诊或计划外住院。我们采用条件逻辑回归比较了连续 12 个月期间的风险，以手术前 13-24 个月为参照期。我们共确定了 11 066 例肥胖合并 CVD 而接受减重手术的成年人。参照期内，20.6%（95%置信区间，19.8-21.3%）的患者因 CVD 而出现 ED 就诊或计划外住院。在随后的术前 12 个月期间，风险并未显著改变（校正比值比[aOR]0.98；95%置信区间，0.93-1.04；P=0.42）。相比之下，减重手术后的第 1 个 12 个月期间，风险显著降低（aOR 0.91；95%置信区间，0.86-0.96；P=0.002）。减重手术后的第 13-24 个月期间，风险仍持续降低（aOR 0.84；95%置信区间，0.79-0.89；P<0.001）。在接受非减重手术（如胆囊切除术、子宫切除术）的单独肥胖人群中，风险并未降低。根据 CVD 类别，减重手术后，急性治疗使用率降低的疾病包括冠状动脉疾病（CAD）、心力衰竭（HF）和高血压，而心律失常和静脉血栓栓塞症的风险则短暂性增加（所有比较的 Bonferroni 校正 P<0.05）。
减重手术与整体 CVD 相关 ED 就诊或计划外住院的风险降低相关。CAD、HF 和高血压的急性治疗使用率降低是减重手术后下降的主要原因。
