Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Br J Surg. 2020 Mar;107(4):432-442. doi: 10.1002/bjs.11433. Epub 2020 Jan 21.
Cohort studies have shown that bariatric surgery may reduce the incidence of and mortality from cardiovascular disease (CVD), but studies using real-world data are limited. This study examined the impact of bariatric surgery on incident CVD, hypertension and atrial fibrillation, and all-cause mortality.
A retrospective, matched, controlled cohort study of The Health Improvement Network primary care database (from 1 January 1990 to 31 January 2018) was performed (approximately 6 per cent of the UK population). Adults with a BMI of 30 kg/m or above who did not have gastric cancer were included as the exposed group. Each exposed patient, who had undergone bariatric surgery, was matched for age, sex, BMI and presence of type 2 diabetes mellitus (T2DM) with two controls who had not had bariatric surgery.
A total of 5170 exposed and 9995 control participants were included; their mean(s.d.) age was 45·3(10·5) years and 21·5 per cent (3265 of 15 165 participants) had T2DM. Median follow-up was 3·9 (i.q.r. 1·8- 6·4) years. Mean(s.d.) percentage weight loss was 20·0(13·2) and 0·8(9·5) per cent in exposed and control groups respectively. Overall, bariatric surgery was not associated with a significantly lower CVD risk (adjusted hazard ratio (HR) 0·80; 95 per cent c.i. 0·62 to 1·02; P = 0·074). Only in the gastric bypass group was a significant impact on CVD observed (HR 0·53, 0·34 to 0·81; P = 0·003). Bariatric surgery was associated with significant reduction in all-cause mortality (adjusted HR 0·70, 0·55 to 0·89; P = 0·004), hypertension (adjusted HR 0·41, 0·34 to 0·50; P < 0·001) and heart failure (adjusted HR 0·57, 0·34 to 0·96; P = 0·033). Outcomes were similar in patients with and those without T2DM (exposed versus controls), except for incident atrial fibrillation, which was reduced in the T2DM group.
Bariatric surgery is associated with a reduced risk of hypertension, heart failure and mortality, compared with routine care. Gastric bypass was associated with reduced risk of CVD compared to routine care.
队列研究表明减重手术可降低心血管疾病（CVD）的发病率和死亡率，但使用真实世界数据的研究有限。本研究旨在评估减重手术对 CVD、高血压和心房颤动以及全因死亡率的影响。
这是一项回顾性、匹配、对照队列研究，基于 The Health Improvement Network 初级保健数据库（1990 年 1 月 1 日至 2018 年 1 月 31 日）开展（约占英国人口的 6%）。BMI 为 30kg/m2 或以上且无胃癌的成年人被纳入研究对象，设为暴露组。暴露组中，每位接受过减重手术的患者与未接受减重手术的 2 名患者相匹配，匹配因素包括年龄、性别、BMI 和 2 型糖尿病（T2DM）的存在。
共纳入 5170 名暴露组和 9995 名对照组参与者，平均年龄（标准差）为 45.3（10.5）岁，21.5%（15165 名参与者中有 3265 名）患有 T2DM。中位随访时间为 3.9 年（四分位距 1.8-6.4）。暴露组和对照组的平均体重减轻率分别为 20.0%（13.2%）和 0.8%（9.5%）。总体而言，减重手术与 CVD 风险显著降低无关（校正后的风险比（HR）为 0.80；95%置信区间为 0.62 至 1.02；P=0.074）。仅在胃旁路手术组观察到对 CVD 的显著影响（HR 为 0.53，0.34 至 0.81；P=0.003）。减重手术与全因死亡率显著降低相关（校正 HR 为 0.70，0.55 至 0.89；P=0.004）、高血压（校正 HR 为 0.41，0.34 至 0.50；P<0.001）和心力衰竭（校正 HR 为 0.57，0.34 至 0.96；P=0.033）。在有和没有 T2DM（暴露组与对照组）的患者中，结果相似，除心房颤动发生率降低外，T2DM 组的心房颤动发生率降低。
与常规护理相比，减重手术可降低高血压、心力衰竭和死亡率的风险。与常规护理相比，胃旁路手术与 CVD 风险降低相关。
