The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Departments of Pharmacy, Health Services, and Economics, University of Washington, Seattle, Washington.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Surg Obes Relat Dis. 2022 Jun;18(6):716-726. doi: 10.1016/j.soard.2022.02.021. Epub 2022 Mar 9.
Comparative evidence is needed when deciding which bariatric operation to undergo for long-term cardiovascular risk reduction.
The Effectiveness of Gastric Bypass vs. Gastric Sleeve for Cardiovascular Disease (ENGAGE CVD) study compared the effectiveness of vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) operations for reduction of the American College of Cardiology and the American Heart Association-predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk 5 years after surgery.
Data for this study came from a large integrated healthcare system in the Southern California region of the United States. This is one of the most ethnically diverse (64% non-White) bariatric populations in the literature.
The ENGAGE CVD cohort consisted of 22,095 patients who underwent VSG or RYGB from 2009-2016. The VSG and RYGB were compared using a local instrumental variable approach to address observed and unobserved confounding, as well as to conduct heterogeneity of treatment effects for patients of different age groups, baseline-predicted 10-year CVD risk using the ASCVD risk score, and those who had type 2 diabetes (T2D) at the time of surgery.
Patients (2771 RYGB and 6256 VVSG) were primarily women (80.6%), Hispanic or non-Hispanic Black (63.7%), and 46 ± 10 years of age, with a body mass index of 43.40 ± 6.5 kg/m. The predicted 10-year ASCVD risk at surgery was 4.1% for VSG and 5.1% for RYGB, decreasing to 2.6% for VSG and 2.8% for RYGB 1 year postoperatively. By 5 years after surgery, patients remained with relatively low risk levels (3.0% for VSG and 3.3% for RYGB) and there were no significant differences in predicted 10-year ASCVD risk between VSG and RYGB at any time.
Predicted 10-year ASCVD risk was low in this population and remained low up to 5 years for those with diabetes, Black and Hispanic patients, and older adults. Literature reporting significant differences between VSG and RYGB in 10-year ASCVD risk may be a result of residual confounding.
在决定进行哪种减重手术以降低长期心血管风险时，需要进行比较性证据评估。
《胃旁路术与胃袖状切除术治疗心血管疾病的效果比较（ENGAGE CVD）》研究比较了垂直袖状胃切除术（VSG）和 Roux-en-Y 胃旁路术（RYGB）在术后 5 年内降低美国心脏病学会和美国心脏协会预测的 10 年动脉粥样硬化性心血管疾病（ASCVD）风险的效果。
本研究的数据来自美国南加州地区一个大型综合医疗保健系统。这是文献中种族最多样化的（64%为非白人）减重人群之一。
ENGAGE CVD 队列由 2009 年至 2016 年期间接受 VSG 或 RYGB 的 22095 名患者组成。使用局部工具变量方法比较了 VSG 和 RYGB，以解决观察到和未观察到的混杂因素，并对不同年龄组患者的治疗效果异质性、使用 ASCVD 风险评分预测的基线 10 年 CVD 风险以及手术时患有 2 型糖尿病（T2D）的患者进行分析。
患者（2771 例 RYGB 和 6256 例 VSG）主要为女性（80.6%）、西班牙裔或非西班牙裔黑人（63.7%），年龄 46±10 岁，体重指数为 43.40±6.5kg/m²。VSG 的手术时预测 10 年 ASCVD 风险为 4.1%，RYGB 为 5.1%，术后 1 年降至 VSG 为 2.6%，RYGB 为 2.8%。术后 5 年，患者的风险水平仍然相对较低（VSG 为 3.0%，RYGB 为 3.3%），且 VSG 和 RYGB 之间在任何时间点的预测 10 年 ASCVD 风险均无显著差异。
在该人群中，预测的 10 年 ASCVD 风险较低，对于糖尿病患者、黑人和西班牙裔患者以及老年人，该风险在 5 年内仍保持较低水平。文献报道 VSG 和 RYGB 在 10 年 ASCVD 风险方面存在显著差异，可能是由于残余混杂因素所致。
