Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China.
Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension Chongqing, China.
Surg Obes Relat Dis. 2022 Apr;18(4):475-483. doi: 10.1016/j.soard.2021.11.019. Epub 2021 Nov 22.
Reducing the risk of death due to cardiovascular disease (CVD) is an important direction for diabetes prevention and treatment. The Chinese population with type 2 diabetes (T2D) has a high risk of developing CVD at relatively low body mass index (BMI) levels. Currently, no studies have evaluated the effect of bariatric surgery versus medical therapy on long-term CVD risk in patients with T2D and low BMI.
To compare bariatric surgery versus medical therapy for long-term CVD risk in Chinese patients with T2D and low BMI by using the China Prediction for ASCVD Risk equations and the United Kingdom Prospective Diabetes Study risk engine.
University hospital, China.
Medical records of patients with T2D with a BMI <35 kg/m undergoing bariatric surgery or medical therapy from May 2010 to December 2018 were reviewed. A 1:1 propensity score matching was performed by using 7 preoperative characteristics. Variables for calculating CVD risk scores over the 5-year follow-up were assessed.
A total of 684 patients with T2D underwent bariatric surgery (n = 75) or medical therapy (n = 609), and 52 pairs of matched subjects were selected from both groups after propensity score matching. The 10-year and lifetime atherosclerotic CVD risk by using the China Prediction for ASCVD Risk equation at 5 years follow-up period in the bariatric surgery group improved significantly compared with the medical therapy group. In the fifth year of follow-up, the 10-year risk of coronary heart disease, fatal coronary heart disease, stroke, and fatal stroke by using the United Kingdom Prospective Diabetes Study risk engine were much lower in the bariatric surgery group than in the medical therapy group (10.37 ± 5.64% versus 27.25 ± 7.28%, P = .004; 6.3 ± 4.5% versus 22.3 ± 7.35%, P = .002; 4.97 ± 3.73% versus 15.05 ± 3.63%, P = .001; .59 ± .45% versus 1.52 ± .14%, P < .001. respectively). The use of glucose-lowering medications, including insulin, was reduced from baseline in both groups, and patients in the bariatric surgery group required significantly fewer of these medications than those in the medical therapy group.
Bariatric surgery in patients with T2D and low BMI conferred a lower calculated risk of CVD compared with medical therapy over 5 years of follow-up.
降低心血管疾病（CVD）导致的死亡风险是糖尿病预防和治疗的一个重要方向。中国 2 型糖尿病（T2D）人群的体质指数（BMI）水平相对较低，但发生 CVD 的风险却很高。目前，尚无研究评估减重手术与药物治疗对 BMI 较低的 T2D 患者长期 CVD 风险的影响。
使用中国 ASCVD 风险预测方程和英国前瞻性糖尿病研究风险引擎，比较减重手术与药物治疗对 BMI 较低的中国 T2D 患者长期 CVD 风险的影响。
大学医院，中国。
回顾了 2010 年 5 月至 2018 年 12 月期间 BMI＜35 kg/m²的 T2D 患者接受减重手术（n=75）或药物治疗（n=609）的病历。使用 7 项术前特征进行 1:1 倾向评分匹配。评估了随访 5 年期间计算 CVD 风险评分的变量。
共 684 例 T2D 患者接受了减重手术（n=75）或药物治疗（n=609），经倾向评分匹配后，两组各选择了 52 对匹配的受试者。与药物治疗组相比，减重手术组在随访 5 年内使用中国 ASCVD 风险预测方程计算的 10 年和终身动脉粥样硬化性 CVD 风险显著改善。在第 5 年随访时，使用英国前瞻性糖尿病研究风险引擎计算的冠心病、致命性冠心病、中风和致命性中风的 10 年风险在减重手术组明显低于药物治疗组（10.37±5.64%比 27.25±7.28%，P=0.004；6.3±4.5%比 22.3±7.35%，P=0.002；4.97±3.73%比 15.05±3.63%，P=0.001；0.59±0.45%比 1.52±0.14%，P＜0.001）。两组患者的降糖药物（包括胰岛素）使用量均从基线下降，减重手术组患者所需的药物明显少于药物治疗组。
与药物治疗相比，BMI 较低的 T2D 患者接受减重手术可在 5 年随访期间降低计算出的 CVD 风险。
