Srinivasan Mirra, Thangaraj Santhosh Raja, Arzoun Hadia, Thomas Siji S, Mohammed Lubna
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2022 Mar 20;14(3):e23340. doi: 10.7759/cureus.23340. eCollection 2022 Mar.
Obesity and its complications are increasing in today's era, with cardiovascular health being one of the most significant obesity-related comorbidities. Hypertension in obesity is considered one of the major causes of death and disability due to their negative repercussions on cardiovascular health. Bariatric surgery is an approved therapeutic modality for obese people in classes II and III who have a body mass index (BMI) of more than 35 kg/m and 40 kg/m, respectively. These weight loss surgeries are procedures that alter metabolism by causing weight reduction and altering gastrointestinal physiology, thereby considerably decreasing cardiometabolic risk factors that have been poorly understood to date. The purpose of this review is to explore the impact of bariatric surgery on reducing cardiac risk factors, in turn protecting the heart from succumbing to premature death. A literature search was done in the following databases: PubMed, Google Scholar, and PubMed Central (PMC). The studies taken into account for this review were observational studies published between 2016 and 2021 in the English language, where the quality was assessed using relevant quality appraisal methodologies. Finally, 10 reports were selected as definitive studies. Upon extensive evaluation of the final studies, it can be concluded that bariatric surgery results in significant weight loss, which lowers metabolic syndrome prevalence, cardiovascular risk factors, and major adverse cardiovascular events, particularly acute coronary events, and a favorable improvement in cardiac structure and function, altogether steering to reduced mortality due to cardiovascular diseases in obese patients. It is also worth noting that, while metabolic surgery can help patients with various metabolic comorbidities, the impact on individuals with hypertension is still debatable. Although the studies show significant effects on the cardiovascular system, these were only observational studies in geographically dispersed locations where each patient's lifestyle patterns and motivational levels could vary. Since real-world data are not fully explored due to the limited randomized controlled trials, it is suggested that further human trials on a larger scale be conducted to provide an even more factual conclusion.
在当今时代，肥胖及其并发症不断增加，心血管健康是与肥胖相关的最严重的合并症之一。肥胖中的高血压因其对心血管健康的负面影响，被认为是死亡和残疾的主要原因之一。减重手术是一种被批准用于体重指数（BMI）分别超过35kg/m²和40kg/m²的II级和III级肥胖人群的治疗方式。这些减肥手术通过减轻体重和改变胃肠生理来改变新陈代谢，从而显著降低迄今为止人们了解甚少的心脏代谢危险因素。本综述的目的是探讨减重手术对降低心脏危险因素的影响，进而保护心脏免于过早死亡。在以下数据库进行了文献检索：PubMed、谷歌学术和美国国立医学图书馆（PMC）。本综述纳入的研究为2016年至2021年期间发表的英文观察性研究，使用相关质量评估方法对其质量进行评估。最后，选择了10份报告作为确定性研究。在对最终研究进行广泛评估后，可以得出结论，减重手术可导致显著体重减轻，从而降低代谢综合征患病率、心血管危险因素和主要不良心血管事件，尤其是急性冠状动脉事件，并使心脏结构和功能得到良好改善，总体上降低肥胖患者心血管疾病导致的死亡率。还值得注意的是，虽然代谢手术可以帮助患有各种代谢合并症的患者，但对高血压患者的影响仍存在争议。尽管这些研究显示对心血管系统有显著影响，但这些只是在地理位置分散的观察性研究，每个患者的生活方式和动机水平可能不同。由于随机对照试验有限，现实世界的数据尚未得到充分探索，建议进行更大规模的进一步人体试验，以得出更符合实际的结论。
