JAMA：减肥手术或可降低心血管事件的发生
2012-01-06 MedSci原创 MedSci原创
1月4日，JAMA杂志上的一则研究"Bariatric Surgery and Long-term Cardiovascular Events"披露，在肥胖者中，减肥手术与心血管死亡及诸如心肌梗塞和中风事件等的长期发生率的减少有关。 大多数的流行病学研究显示，肥胖症与心血管性事件及死亡的增加有关。根据文章的背景资料：“减肥可能会防止心血管事件的发生，但确凿的证据仍然缺乏。” 瑞典哥德堡大学
1月4日，JAMA杂志上的一则研究"Bariatric Surgery and Long-term Cardiovascular Events"披露，在肥胖者中，减肥手术与心血管死亡及诸如心肌梗塞和中风事件等的长期发生率的减少有关。
大多数的流行病学研究显示，肥胖症与心血管性事件及死亡的增加有关。根据文章的背景资料：“减肥可能会防止心血管事件的发生，但确凿的证据仍然缺乏。”
瑞典哥德堡大学的Lars Sjostrom, M.D., Ph.D.及其同事开展了一项研究，旨在测试减肥手术与心血管事件发生率的下降有关的假说，并对体重变化与心血管事件之间的关系进行了考查。这项研究（瑞典肥胖者[SOS]）是一个在瑞典的25家公立医院外科部门和480家初级医疗中心中开展的持续性、非随机、前瞻性且有对照的研究；该研究包括了2010位接受了减肥手术的肥胖症参与者及2037位配对的只接受常规治疗的对照组肥胖症患者。这些病人是在1987年9月至2001年1月间招募的。开展分析的日期是2009年12月31日，随访的中位数（中点）为14.7年。
在随访期间，对照组病人中出现了49例心血管性死亡，手术组病人中出现了28例心血管性死亡。就总数而言（致命性及非致命性），对照组的病人中发生了234起心血管性事件，手术组的病人中发生了199起心血管性事件。在对一些变量进行调整之后，减肥手术与致命性心血管性死亡人数的降低及较低的心血管性事件总数有关。
减肥手术与致命性心肌梗塞性死亡数的降低有关（手术组中有22例 vs. 对照组中有37例），且分析表明，减肥手术与致命性心肌梗塞发生率及总体心肌梗塞发生率的降低都有关系。另外，减肥手术与致命性中风事件及总体中风事件数的降低都有关系。
“总之，据我们所知，这是第一个有关减肥手术与心血管性死亡及心血管事件发生率的降低有相关性的前瞻性、设有对照的治疗干预报告。这些结果 —— 加上我们先前报告的在减肥手术与有关体重、心血管风险因子、生活品质、糖尿病、癌症及死亡率等长期改变的有利后果间具有相关性 —— 表明减肥手术有着许多裨益，其中有些裨益是独立于手术带来的减肥程度之外的。”（生物谷bioon.com）
Bariatric Surgery and Long-term Cardiovascular Events
Lars Sjstrm, MD, PhD; Markku Peltonen, PhD; Peter Jacobson, MD, PhD; C. David Sjstrm, MD, PhD; Kristjan Karason, MD, PhD; Hans Wedel, PhD; Sofie Ahlin, MD; sa Anveden, MD;et al.
Context Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking.
Objective To study the association between bariatric surgery, weight loss, and cardiovascular events.
Design, Setting, and Participants The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals.
Main Outcome Measures The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined.
Results Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P < .001).
Conclusion Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.
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