Skip to main content
Erschienen in: Obesity Surgery 1/2015

01.01.2015 | Original Contributions

Cardiovascular Risk Profile in Mediterranean Patients Submitted to Bariatric Surgery and Intensive Lifestyle Intervention: Impact of Both Interventions After 1 Year of Follow-Up

verfasst von: Pilar Sanchis, Carla Frances, Joana Nicolau, Rosmeri Rivera, Regina Fortuny, Xavier Julian, Salvador Pascual, Luis A. Gomez, Irene Rodriguez, Josefina Olivares, Luisa Ayala, Luis Masmiquel

Erschienen in: Obesity Surgery | Ausgabe 1/2015

Einloggen, um Zugang zu erhalten

Abstract

Background

The aim was to compare obesity-related cardiovascular (CV) risk factors (classic and emerging) and the estimated CV risk at 10 years (calculated by REGICOR) in obese Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention at baseline and after 1 year of follow-up.

Methods

Patients submitted to bariatric surgery (n = 108) and standardized program of therapeutic changes in lifestyle (n = 90) were retrospectively included. Clinical history, physical examination, and laboratory analysis were routinely determined before weight loss intervention and at 1 year follow-up.

Results

Seventy-five percent of the surgery patients had a CV risk lower than 5 % and not one patient had a 10-year CV risk higher than 15 %. The percentage of patients with comorbidities (diabetes and sleep apnea syndrome) was higher in the surgery group. Seventeen of the surgery patients had no comorbidities. The improvement in CV risk profile was significant higher in the surgery group. CV risk benefit of both intervention groups was related to baseline higher CV risk, with type 2 diabetes with poor metabolic control and high cholesterol levels being the most important predictors for surgery patients. Neither body mass index nor excess of weight loss was related to CV risk improvement.

Conclusions

Mediterranean patients undergoing a weight loss intervention have a low CV risk. In comparison with lifestyle intervention, surgery induces a better improvement of CV risk. This benefit is related to estimated CV risk, presence of diabetes, and cholesterol levels at baseline. These observations should be taken into account in order to optimize health resources.
Literatur
1.
Zurück zum Zitat Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355(8):763–78.PubMedCrossRef Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355(8):763–78.PubMedCrossRef
4.
Zurück zum Zitat The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration BMI Mediated Effects). Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet. 2013. doi:10.1016/S0140-6736(13)61836-X. The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration BMI Mediated Effects). Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet. 2013. doi:10.​1016/​S0140-6736(13)61836-X.
7.
Zurück zum Zitat Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. JAMA. 2003;290(7):932–40.PubMedCrossRef Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. JAMA. 2003;290(7):932–40.PubMedCrossRef
9.
13.
Zurück zum Zitat Hofsø D, Nordstrand N, Johnson LK, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163(5):735–45. doi:10.1530/EJE-10-0514.PubMedCentralPubMedCrossRef Hofsø D, Nordstrand N, Johnson LK, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163(5):735–45. doi:10.​1530/​EJE-10-0514.PubMedCentralPubMedCrossRef
18.
Zurück zum Zitat Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–52.PubMedCrossRef Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–52.PubMedCrossRef
19.
Zurück zum Zitat National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.
20.
Zurück zum Zitat Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999 22(5):667-89. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999 22(5):667-89.
21.
Zurück zum Zitat Wood D, De Backer G, Faergeman O, et al. Task Force Report. Prevention of coronary heart disease in clinical practice: recommendations of the second joint task force of the joint European Societies on coronary prevention. Eur Heart J. 1998;19(10):1434–503.CrossRef Wood D, De Backer G, Faergeman O, et al. Task Force Report. Prevention of coronary heart disease in clinical practice: recommendations of the second joint task force of the joint European Societies on coronary prevention. Eur Heart J. 1998;19(10):1434–503.CrossRef
22.
Zurück zum Zitat Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001 16;285(19):2486-97. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001 16;285(19):2486-97.
23.
Zurück zum Zitat Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004;110(2):227–39.PubMedCrossRef Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004;110(2):227–39.PubMedCrossRef
24.
Zurück zum Zitat Anderson KM, Wilson PWF, Odell PM, et al. An updated coronary risk profile. A statement for health professionals. Circulation. 1991;83(1):356–62.PubMedCrossRef Anderson KM, Wilson PWF, Odell PM, et al. An updated coronary risk profile. A statement for health professionals. Circulation. 1991;83(1):356–62.PubMedCrossRef
25.
Zurück zum Zitat Wilson PWF, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.PubMedCrossRef Wilson PWF, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.PubMedCrossRef
26.
Zurück zum Zitat Menotti A, Lanti M, Puddu PE, et al. Coronary heart disease incidence in northern and southern European populations: a reanalysis of the seven countries study for a European coronary risk chart. Heart. 2000;84(3):238–44.PubMedCentralPubMedCrossRef Menotti A, Lanti M, Puddu PE, et al. Coronary heart disease incidence in northern and southern European populations: a reanalysis of the seven countries study for a European coronary risk chart. Heart. 2000;84(3):238–44.PubMedCentralPubMedCrossRef
27.
Zurück zum Zitat Menotti A, Puddu PE, Lanti M. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J. 2000;21(5):365–70.PubMedCrossRef Menotti A, Puddu PE, Lanti M. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J. 2000;21(5):365–70.PubMedCrossRef
28.
Zurück zum Zitat Marrugat J, Solanas P, D’Agostino R, et al. Coronary risk estimation in Spain using a calibrated Framingham function. Rev Esp Cardiol. 2003;56(3):253–61.PubMedCrossRef Marrugat J, Solanas P, D’Agostino R, et al. Coronary risk estimation in Spain using a calibrated Framingham function. Rev Esp Cardiol. 2003;56(3):253–61.PubMedCrossRef
29.
Zurück zum Zitat Marrugat J, D'Agostino R, Sullivan L, et al. An adaptation of the Framingham coronary risk function to southern Europe Mediterranean areas. J Epidemiol Community Health. 2003;57(8):634–8.PubMedCentralPubMedCrossRef Marrugat J, D'Agostino R, Sullivan L, et al. An adaptation of the Framingham coronary risk function to southern Europe Mediterranean areas. J Epidemiol Community Health. 2003;57(8):634–8.PubMedCentralPubMedCrossRef
30.
Zurück zum Zitat Comín E, Solanas P, Cabezas C, et al. Estimating cardiovascular risk in Spain using different algorithms. Rev Esp Cardiol. 2007;60(7):693–702.PubMedCrossRef Comín E, Solanas P, Cabezas C, et al. Estimating cardiovascular risk in Spain using different algorithms. Rev Esp Cardiol. 2007;60(7):693–702.PubMedCrossRef
31.
Zurück zum Zitat Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: The Framingham Study. Diabetes Care. 1979;2(2):120–6.PubMedCrossRef Kannel WB, McGee DL. Diabetes and glucose tolerance as risk factors for cardiovascular disease: The Framingham Study. Diabetes Care. 1979;2(2):120–6.PubMedCrossRef
32.
Zurück zum Zitat Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.PubMedCrossRef Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76–9.PubMedCrossRef
35.
Zurück zum Zitat Dixon JB, Dixon ME, O'Brien PE. Pre-operative predictors of weight loss at 1-year after Lap-Band surgery. Obes Surg. 2001;11(2):200–7.PubMedCrossRef Dixon JB, Dixon ME, O'Brien PE. Pre-operative predictors of weight loss at 1-year after Lap-Band surgery. Obes Surg. 2001;11(2):200–7.PubMedCrossRef
37.
Zurück zum Zitat Martins C, Strømmen M, Stavne OA, et al. Bariatric surgery versus lifestyle interventions for morbid obesity–changes in body weight, risk factors and comorbidities at 1 year. Obes Surg. 2011;21(7):841–9. doi:10.1007/s11695-010-0131-1.PubMedCrossRef Martins C, Strømmen M, Stavne OA, et al. Bariatric surgery versus lifestyle interventions for morbid obesity–changes in body weight, risk factors and comorbidities at 1 year. Obes Surg. 2011;21(7):841–9. doi:10.​1007/​s11695-010-0131-1.PubMedCrossRef
40.
Zurück zum Zitat Dixon JB, Dixon ME, O'Brien PE. Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. Int J Obes Relat Metab Disord. 2001;25(2):219–27.PubMedCrossRef Dixon JB, Dixon ME, O'Brien PE. Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. Int J Obes Relat Metab Disord. 2001;25(2):219–27.PubMedCrossRef
41.
Zurück zum Zitat Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6. discussion 757-8.PubMedCentralPubMed Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6. discussion 757-8.PubMedCentralPubMed
42.
48.
Zurück zum Zitat Gómez-Ambrosi J, Silva C, Galofré JC, et al. Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. Int J Obes (Lond). 2012;36(2):286–94. doi:10.1038/ijo.2011.100.CrossRef Gómez-Ambrosi J, Silva C, Galofré JC, et al. Body mass index classification misses subjects with increased cardiometabolic risk factors related to elevated adiposity. Int J Obes (Lond). 2012;36(2):286–94. doi:10.​1038/​ijo.​2011.​100.CrossRef
49.
50.
Zurück zum Zitat Benaiges D, Goday A, Ramon JM, et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis. 2011;7(5):575–80. doi:10.1016/j.soard.2011.03.002.PubMedCrossRef Benaiges D, Goday A, Ramon JM, et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis. 2011;7(5):575–80. doi:10.​1016/​j.​soard.​2011.​03.​002.PubMedCrossRef
Metadaten
Titel
Cardiovascular Risk Profile in Mediterranean Patients Submitted to Bariatric Surgery and Intensive Lifestyle Intervention: Impact of Both Interventions After 1 Year of Follow-Up
verfasst von
Pilar Sanchis
Carla Frances
Joana Nicolau
Rosmeri Rivera
Regina Fortuny
Xavier Julian
Salvador Pascual
Luis A. Gomez
Irene Rodriguez
Josefina Olivares
Luisa Ayala
Luis Masmiquel
Publikationsdatum
01.01.2015
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 1/2015
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-014-1321-z

Weitere Artikel der Ausgabe 1/2015

Obesity Surgery 1/2015 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.