Wang Lei, O'Brien Michael T, Zhang Xinmeng, Chen You, English Wayne J, Williams Brandon, Spann Matthew, Albaugh Vance, Shu Xiao-Ou, Flynn Charles R, Yu Danxia
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
School of Medicine, Vanderbilt University, Nashville, TN 37203, USA.
J Endocr Soc. 2024 Mar 14;8(5):bvae027. doi: 10.1210/jendso/bvae027. eCollection 2024 Mar 12.
Metabolic surgery remains the most effective and durable treatment for severe obesity and related metabolic diseases.
We examined cardiometabolic improvements after metabolic surgery and associated presurgery demographic and clinical factors in a large multiracial cohort.
Included were 7804 patients (20-79 years) undergoing first-time metabolic surgery at Vanderbilt University Medical Center from 1999 to 2022. Pre- and 1-year postsurgery cardiometabolic profiles were extracted from medical records, including body mass index (BMI), blood pressure, blood lipids, glucose, and hemoglobin A1c. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk was estimated per American College of Cardiology/American Heart Association equations. Pre- to postsurgery cardiometabolic profiles were compared by paired t-test, and associated factors were identified by multivariable linear and logistic regression.
Among 7804 patients, most were women and White, while 1618 were men and 1271 were Black; median age and BMI were 45 years [interquartile range (IQR): 37-53] and 46.4 kg/m (IQR: 42.1-52.4). At 1-year postsurgery, patients showed significant decreases in systolic blood pressure (10.5 [95% confidence interval: 10.1, 10.9] mmHg), total cholesterol (13.5 [10.3, 16.7] mg/dL), glucose (13.6 [12.9, 14.4] mg/dL), hemoglobin A1c (1.13% [1.06, 1.20]), and 10-year ASCVD risk (absolute reduction: 1.58% [1.22, 1.94]; relative reduction: 34.4% [29.4, 39.3]); all < .0001. Older, male, or Black patients showed less reduction in 10-year ASCVD risk and lower odds of diabetes/hypertension/dyslipidemia remission than younger, female, or White patients. Patients with a history of diabetes, hypertension, dyslipidemia, or cardiovascular disease showed less cardiometabolic improvements than those without. Results were similar with or without further adjusting for weight loss and largely sustained at 2-year postsurgery.
Metabolic surgery results in significant cardiometabolic improvements, particularly among younger, female, or White patients and those without comorbidities.
代谢手术仍然是治疗重度肥胖及相关代谢性疾病最有效且持久的方法。
我们在一个大型多种族队列中研究了代谢手术后心脏代谢指标的改善情况以及术前相关的人口统计学和临床因素。
纳入了1999年至2022年在范德比尔特大学医学中心接受首次代谢手术的7804例患者（20 - 79岁）。从病历中提取术前和术后1年的心脏代谢指标，包括体重指数（BMI）、血压、血脂、血糖和糖化血红蛋白A1c。根据美国心脏病学会/美国心脏协会的公式估算10年动脉粥样硬化性心血管疾病（ASCVD）风险。术前和术后的心脏代谢指标通过配对t检验进行比较，并通过多变量线性和逻辑回归确定相关因素。
在7804例患者中，大多数为女性和白人，其中1618例为男性，1271例为黑人；年龄中位数和BMI分别为45岁[四分位间距（IQR）：37 - 53]和46.4 kg/m²（IQR：42.1 - 52.4）。术后1年，患者的收缩压（10.5 [95%置信区间：10.1, 10.9] mmHg）、总胆固醇（13.5 [10.3, 16.7] mg/dL）、血糖（13.6 [12.9, 14.4] mg/dL）、糖化血红蛋白A1c（1.13% [1.06, 1.20]）以及10年ASCVD风险（绝对降低：1.58% [1.22, 1.94]；相对降低：34.4% [29.4, 39.3]）均显著降低；所有P <.0001。年龄较大、男性或黑人患者的10年ASCVD风险降低幅度较小，糖尿病/高血压/血脂异常缓解的几率低于年龄较小、女性或白人患者。有糖尿病、高血压、血脂异常或心血管疾病病史的患者心脏代谢指标改善程度低于无这些病史的患者。无论是否进一步调整体重减轻情况，结果相似，且在术后2年基本保持。
代谢手术可显著改善心脏代谢指标，尤其是在年龄较小、女性或白人患者以及无合并症的患者中。
