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代谢手术与2型糖尿病和肥胖患者主要不良心血管结局的关系
作者:小柯机器人 发布时间:2019/9/4 17:06:41

美国俄亥俄州克利夫兰诊所Steven E. Nissen与合作者在最新研究中探讨了2型糖尿病合并肥胖症患者代谢手术与心血管事件的关系。相关论文2019年9月2日在线发表于《美国医学会杂志》。

1998至2017年,美国克利夫兰诊所健康系统的287438名成人糖尿病患者中有2287名接受了代谢手术。在这项回顾性队列研究中,11435名非手术的糖尿病和肥胖患者(体重指数≥30)作为对照组,随访至2018年12月。两组间性别、年龄、体重指数和糖化蛋白水平等一般资料相比无统计学差异。主要不良心血管事件(MACE)定义为首次全因死亡、冠状动脉事件、脑血管事件、心力衰竭、肾病和心房颤动。

中位随访3.9年后,手术组中有385名(30.8%)患者发生MACE,显著低于非手术组(3243名,47.7%),校正风险比为0.61。手术组中全因死亡112例(10.0%),显著低于非手术组(17.8%),校正风险比为0.59。

综上,在2型糖尿病和肥胖症患者中,代谢手术与非手术治疗相比,显著降低了MACE的风险。

据悉,尽管代谢手术明显改善了心脏代谢的危险因素,但对心血管结局影响的研究寥寥无几。

附:英文原文

Title: Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity

Author: Ali Aminian, MD1; Alexander Zajichek, MS2; David E. Arterburn, MD, MPH3; Kathy E. Wolski, MPH4; Stacy A. Brethauer, MD1,5; Philip R. Schauer, MD1; Michael W. Kattan, PhD2; Steven E. Nissen, MD4

Issue&Volume: September 2, 2019

Abstract:

Importance  Although metabolic surgery (defined as procedures that influence metabolism by inducing weight loss and altering gastrointestinal physiology) significantly improves cardiometabolic risk factors, the effect on cardiovascular outcomes has been less well characterized.

Objective  To investigate the relationship between metabolic surgery and incident major adverse cardiovascular events (MACE) in patients with type 2 diabetes and obesity.

Design, Setting, and Participants  Of 287?438 adult patients with diabetes in the Cleveland Clinic Health System in the United States between 1998 and 2017, 2287 patients underwent metabolic surgery. In this retrospective cohort study, these patients were matched 1:5 to nonsurgical patients with diabetes and obesity (body mass index [BMI] ≥30), resulting in 11?435 control patients, with follow-up through December 2018.

Exposures  Metabolic gastrointestinal surgical procedures vs usual care for type 2 diabetes and obesity.

Main Outcomes and Measures  The primary outcome was the incidence of extended MACE (composite of 6 outcomes), defined as first occurrence of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, nephropathy, and atrial fibrillation. Secondary end points included 3-component MACE (myocardial infarction, ischemic stroke, and mortality) and the 6 individual components of the primary end point.

Results  Among the 13?722 study participants, the distribution of baseline covariates was balanced between the surgical group and the nonsurgical group, including female sex (65.5% vs 64.2%), median age (52.5 vs 54.8 years), BMI (45.1 vs 42.6), and glycated hemoglobin level (7.1% vs 7.1%). The overall median follow-up duration was 3.9 years (interquartile range, 1.9-6.1 years). At the end of the study period, 385 patients in the surgical group and 3243 patients in the nonsurgical group experienced a primary end point (cumulative incidence at 8-years, 30.8% [95% CI, 27.6%-34.0%] in the surgical group and 47.7% [95% CI, 46.1%-49.2%] in the nonsurgical group [P < .001]; absolute 8-year risk difference [ARD], 16.9% [95% CI, 13.1%-20.4%]; adjusted hazard ratio [HR], 0.61 [95% CI, 0.55-0.69]). All 7 prespecified secondary outcomes showed statistically significant differences in favor of metabolic surgery, including mortality. All-cause mortality occurred in 112 patients in the metabolic surgery group and 1111 patients in the nonsurgical group (cumulative incidence at 8 years, 10.0% [95% CI, 7.8%-12.2%] and 17.8% [95% CI, 16.6%-19.0%]; ARD, 7.8% [95% CI, 5.1%-10.2%]; adjusted HR, 0.59 [95% CI, 0.48-0.72]).

Conclusions and Relevance  Among patients with type 2 diabetes and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MACE. The findings from this observational study must be confirmed in randomized clinical trials.

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex