Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, Gothenburg, 41650, Sweden.
Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
ESC Heart Fail. 2022 Jun;9(3):1844-1852. doi: 10.1002/ehf2.13880. Epub 2022 Mar 11.
We aim to assess the risk of heart failure in patients with obesity with and without gastric bypass surgery compared with population controls.
This cohort study included all patients aged 20-65 years with a first ever registered principal diagnosis of obesity in the Swedish Patient Register in 2001-2013. These patients were matched by age, sex, and region with two population controls from the general Swedish population without obesity diagnosis. The obesity cohort was divided into two groups: 27 882 patients who had undergone gastric bypass surgery within 2 years of obesity diagnosis and 39 564 patients who had not undergone such surgery. These groups were compared with 55 149 and 78 004 matched population controls, respectively. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, education, and sex. During follow-up (maximum 10 years, median 4.4 years, and interquartile range 2.5-7.2 years), 1884 participants were hospitalized for heart failure. Compared with population controls, gastric bypass patients had no excess risk of heart failure during the initial 0-≤4 years of follow-up (HR = 1.35 [95% CI = 0.96-1.91]) but a marked increased risk during the final >4-10 years of follow-up (HR = 3.28 [95% CI = 2.25-4.77]). Non-operated patients with obesity had a marked excess risk of heart failure throughout the study period compared with population controls.
Gastric bypass for obesity seems to reduce the risk of heart failure to levels similar to the general population during the initial 4 years after surgery, but not thereafter.
我们旨在评估肥胖患者在接受和未接受胃旁路手术与人群对照者相比发生心力衰竭的风险。
本队列研究纳入了所有 2001-2013 年在瑞典患者登记处首次确诊为肥胖的 20-65 岁患者。这些患者按年龄、性别和地区与一般瑞典人群中无肥胖诊断的 2 名人群对照者进行匹配。肥胖队列分为两组：肥胖诊断后 2 年内接受胃旁路手术的 27882 例患者和未接受此类手术的 39564 例患者。分别与 55149 例和 78004 例匹配的人群对照者进行比较。Cox 回归提供了风险比（HR）及其 95%置信区间（CI），并校正了年龄、教育程度和性别。在随访期间（最长 10 年，中位数 4.4 年，四分位间距 2.5-7.2 年），1884 名患者因心力衰竭住院。与人群对照者相比，胃旁路手术患者在最初 0-≤4 年的随访期间没有心力衰竭的超额风险（HR=1.35[95%CI=0.96-1.91]），但在最后>4-10 年的随访期间风险显著增加（HR=3.28[95%CI=2.25-4.77]）。肥胖未手术患者在整个研究期间与人群对照者相比，心力衰竭的风险显著增加。
肥胖患者接受胃旁路手术似乎可降低心力衰竭风险，使其在手术后最初 4 年内与一般人群相似，但此后并非如此。
