Department of Surgery, Dignity Health, Santa Maria, California.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Surg Obes Relat Dis. 2024 Jan;20(1):18-28. doi: 10.1016/j.soard.2023.07.009. Epub 2023 Aug 4.
Patients with metabolic syndrome (MetS) are at increased risk of developing cardiovascular disease along with other adverse events after bariatric surgery.
The incidence of short-term major adverse cardiovascular events (MACE) in patients with MetS undergoing bariatric surgery is not well characterized.
Accredited bariatric surgery centers in the United States and Canada.
A total of 760,076 patients aged ≥18 years with body mass index ≥35 kg/m who underwent primary bariatric surgery between 2015 and 2018 were included. Patients with both diabetes and hypertension were described as the MetS cohort. Patient characteristics, operative technique, and 30-day outcomes were compared. The primary outcome was incidence of MACE, a composite of myocardial infarction, stroke, and all-cause mortality. Unadjusted and multivariable logistic regression analyses were performed and included an interaction between MetS and hyperlipidemia (HLD).
Of the 577,882 patients included, 111,128 (19.2%) exhibited MetS. Patients with MetS more frequently experienced MACE compared with patients without MetS (.3% versus .1%; P < .001). The odds of MACE were greater for patients with MetS versus Non-MetS (odds ratio [OR] 2.87; 95% CI, 2.49-3.32) in the unadjusted analysis. MetS without HLD, MetS with HLD, and Non-MetS with HLD are significantly associated with MACE when compared with those with non-MetS without HLD.
Patients with MetS have an increased frequency of cardiac events following bariatric surgery. Future studies should determine if optimization of 1 or more components of MetS or other related co-morbidities reduces the cardiovascular risk for patients.
代谢综合征（MetS）患者在接受减重手术后发生心血管疾病和其他不良事件的风险增加。
代谢综合征患者接受减重手术后短期主要不良心血管事件（MACE）的发生率尚不清楚。
美国和加拿大的认证减重手术中心。
共纳入 2015 年至 2018 年间年龄≥18 岁、BMI≥35kg/m²的 760076 例接受初次减重手术的患者。同时患有糖尿病和高血压的患者被描述为代谢综合征组。比较患者特征、手术技术和 30 天结局。主要结局是 MACE 的发生率，复合终点为心肌梗死、卒中和全因死亡率。进行了未调整和多变量逻辑回归分析，并包括代谢综合征和高脂血症（HLD）之间的交互作用。
在纳入的 577882 例患者中，111128 例（19.2%）存在代谢综合征。与无代谢综合征的患者相比，有代谢综合征的患者更常发生 MACE（0.3%比 0.1%；P<0.001）。在未调整分析中，与非代谢综合征患者相比，代谢综合征患者发生 MACE 的可能性更大（优势比[OR]2.87；95%置信区间，2.49-3.32）。与非代谢综合征且无 HLD 患者相比，无 HLD 的代谢综合征、有 HLD 的代谢综合征和有 HLD 的非代谢综合征患者的 MACE 发生率显著增加。
代谢综合征患者在接受减重手术后发生心脏事件的频率增加。未来的研究应确定是否优化代谢综合征的 1 个或多个组成部分或其他相关合并症可以降低患者的心血管风险。
