Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
Ann Surg. 2020 Oct;272(4):639-645. doi: 10.1097/SLA.0000000000004369.
The aim of this study was to determine the minimum amount of weight loss required to see a reduction in major adverse cardiovascular events (MACE).
Although obesity is an established risk factor for morbidity and mortality, the minimum amount of weight loss to have a meaningful impact on cardiovascular health and survival is unknown.
Patients with obesity (body mass index ≥30 kg/m) and type 2 diabetes who underwent metabolic surgery in an academic center (1998-2017) were propensity-matched 1:5 to nonsurgical patients who received usual care. The adjusted linear and nonlinear effects of weight loss (achieved in the first 18 months after the index date) were studied to identify cut-offs for the minimum weight loss to achieve decreased risk of all-cause mortality and MACE (composite of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, nephropathy, and atrial fibrillation).
A total of 7201 patients (1223 surgical and 5978 nonsurgical) with a median follow-up time of 4.9 years (interquartile range, 3.5-7) were included. The positive effect of metabolic surgery was still present after adjusting for weight loss amounts, suggesting that there are weight loss-independent factors contributing to a reduction in risk of MACE and all-cause mortality in the surgical cohort. After considering the weighted estimates from a diverse set of models, the risk of MACE decreases after approximately 10% of weight is lost in the surgical group and approximately 20% in the nonsurgical group. For all-cause mortality, the threshold for benefit appeared to be approximately 5% weight loss after metabolic surgery and 20% in the nonsurgical group.
This large matched-cohort study identified the minimum weight loss thresholds for reduction in risk of MACE and all-cause mortality in patients with obesity and diabetes. Furthermore, in our analysis, the effect of surgery was still present after accounting for weight loss, which may suggest the presence of weight-independent beneficial effects of metabolic surgery on MACE and survival.
本研究旨在确定体重减轻的最低量，以观察主要不良心血管事件（MACE）的减少。
尽管肥胖是发病率和死亡率的既定危险因素，但体重减轻多少才能对心血管健康和生存产生有意义的影响尚不清楚。
对在学术中心接受代谢手术的肥胖（体重指数≥30kg/m）和 2 型糖尿病患者（1998-2017 年）进行倾向匹配，以 1：5 的比例与接受常规护理的非手术患者进行匹配。研究体重减轻（在指数日期后的前 18 个月内实现）的调整线性和非线性影响，以确定体重减轻的最低量的截止值，以降低全因死亡率和 MACE（全因死亡率、冠状动脉事件、脑血管事件、心力衰竭、肾病和心房颤动的复合）的风险。
共纳入 7201 例患者（1223 例手术和 5978 例非手术），中位随访时间为 4.9 年（四分位距，3.5-7）。在调整体重减轻量后，代谢手术的积极影响仍然存在，这表明手术组中存在与体重减轻无关的因素，可降低 MACE 和全因死亡率的风险。在考虑了来自各种模型的加权估计值后，手术组中体重减轻约 10%后 MACE 风险降低，非手术组中体重减轻约 20%后 MACE 风险降低。对于全因死亡率，代谢手术后体重减轻约 5%，非手术组中体重减轻约 20%时，获益的阈值似乎出现。
这项大型匹配队列研究确定了肥胖和糖尿病患者降低 MACE 和全因死亡率风险的最低体重减轻阈值。此外，在我们的分析中，在考虑体重减轻后，手术的效果仍然存在，这可能表明代谢手术对 MACE 和生存具有与体重无关的有益影响。
