Department of Molecular and Clinical Medicine University of Gothenburg Sweden.
Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden.
J Am Heart Assoc. 2021 Apr 6;10(7):e019323. doi: 10.1161/JAHA.120.019323. Epub 2021 Mar 23.
Background Obesity and diabetes mellitus are strongly associated with heart failure (HF) and atrial fibrillation (AF). The benefits of bariatric surgery on cardiovascular outcomes are known in people with or without diabetes mellitus. Surgical treatment of obesity might also reduce the incidence of HF and AF in individuals with obesity and type 2 diabetes mellitus (T2DM). Methods and Results In this register-based nationwide cohort study we compared individuals with T2DM and obesity who underwent Roux-en-Y gastric bypass surgery with matched individuals not treated with surgery. The main outcome measures were hospitalization for HF and/or AF and mortality in patients with preexisting HF. We identified 5321 individuals with T2DM and obesity who had undergone Roux-en-Y gastric bypass surgery between January 2007 and December 2013 and 5321 matched controls. The individuals included were 18 to 65 years old and had a body mass index >27.5 kg/m. The follow-up time for hospitalization was until the end of 2015 (mean 4.5 years) and the end of 2016 for death. Our results show a 73% lower risk for HF (hazard ratio [HR], 0.27; CI, 0.19-0.38), 41% for AF (HR, 0.59; CI, 0.44-0.78), and 77% for concomitant AF and HF (HR, 0.23; CI, 0.12-0.46) in the surgically treated group. In patients with preexisting HF we observed significantly lower mortality in the group who underwent surgery (HR, 0.23; 95% CI, 0.12-0.43). Conclusions Bariatric surgery may reduce risk for HF and AF in patients with T2DM and obesity, speculatively via positive cardiovascular and renal effects. Obesity treatment with surgery may also be a valuable alternative in selected patients with T2DM and HF.
肥胖和糖尿病与心力衰竭（HF）和心房颤动（AF）密切相关。减重手术对心血管结局的益处已在有或没有糖尿病的人群中得到证实。肥胖症的手术治疗也可能降低肥胖和 2 型糖尿病（T2DM）患者 HF 和 AF 的发生率。
在这项基于登记的全国性队列研究中，我们比较了接受 Roux-en-Y 胃旁路手术与未接受手术治疗的 T2DM 和肥胖患者。主要观察指标为合并 HF 患者的 HF 和/或 AF 住院和死亡率。我们确定了 2007 年 1 月至 2013 年 12 月期间接受 Roux-en-Y 胃旁路手术的 5321 名 T2DM 和肥胖患者和 5321 名匹配对照。纳入的患者年龄在 18 至 65 岁之间，体重指数（BMI）>27.5kg/m2。HF 住院的随访时间截止到 2015 年底（平均 4.5 年），死亡的随访时间截止到 2016 年底。我们的研究结果表明，手术组 HF 的风险降低了 73%（风险比[HR]，0.27；95%CI，0.19-0.38），AF 降低了 41%（HR，0.59；95%CI，0.44-0.78），同时伴有 AF 和 HF 的患者降低了 77%（HR，0.23；95%CI，0.12-0.46）。在合并 HF 的患者中，手术组的死亡率显著降低（HR，0.23；95%CI，0.12-0.43）。
减重手术可能降低 T2DM 和肥胖患者 HF 和 AF 的风险，推测可能通过对心血管和肾脏的积极影响。在有选择的 T2DM 和 HF 患者中，手术治疗肥胖可能是一种有价值的替代方法。
