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Erschienen in: Langenbeck's Archives of Surgery 1/2021

10.11.2020 | Original Article

The long-term risk of cardiovascular events in patients following bariatric surgery compared to a non-surgical population with obesity and the general population: a comprehensive national cohort study

verfasst von: Shao-Lun Hung, Chung-Yen Chen, Wei-Leng Chin, Cheng-Hung Lee, Jian-Han Chen

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 1/2021

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Abstract

Purpose

This study evaluated the differences in long-term cardiovascular events between obese patients who received bariatric surgery (BS), those who did not, and the general population (GP).

Methods

Between 2003 and 2008, patients with severe obesity, aged 18–55 years, were divided into the non-surgical (NS) and BS groups and were included in this retrospective study. We also extracted data of healthy civilians defined as the GP. The incidence of cardiovascular events, including myocardial infarction, intracranial hemorrhage, epidural hemorrhage, ischemic stroke, and transient ischemic attack, was defined as the primary end point. Patients were followed up either until the end of 2013, upon reaching the primary end point, or death.

Results

After propensity score matching, 1436 patients were included in both the BS and NS groups, and 4829 subjects were enrolled as the GP. Of these, 57 (3.9%), 10 (0.6%), and 30 (0.62%) subjects in the NS, BS, and GP, respectively, experienced cardiovascular events. Multivariate analysis revealed that patients with BS had a significantly lower risk of cardiovascular events (HR = 0.168; 95% CI 0.085–0.328; p < 0.001) than those in the NS group, but it was not significantly different in the BS group compared with the GP (HR = 1.202; 95% CI 0.585–2.471; p = 0.617).

Conclusion

Long-term risk of cardiovascular events was significantly lower among patients who had BS, compared to the NS obese patients. Thus, the long-term cardiovascular risk between those who received BS and the GP had no significant difference, in a retrospective view.
Literatur
2.
Zurück zum Zitat Buchwald H (2005) Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis 1:371–381CrossRef Buchwald H (2005) Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis 1:371–381CrossRef
3.
Zurück zum Zitat Engin A (2017) The definition and prevalence of obesity and metabolic syndrome. Adv Exp Med Biol 960:1–17CrossRef Engin A (2017) The definition and prevalence of obesity and metabolic syndrome. Adv Exp Med Biol 960:1–17CrossRef
4.
Zurück zum Zitat Butryn ML, Webb V, Wadden TA (2011) Behavioral treatment of obesity. Psychiatr Clin North Am 34:841–859CrossRef Butryn ML, Webb V, Wadden TA (2011) Behavioral treatment of obesity. Psychiatr Clin North Am 34:841–859CrossRef
5.
Zurück zum Zitat Nguyen NT, Varela JE (2017) Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol 14:160–169CrossRef Nguyen NT, Varela JE (2017) Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol 14:160–169CrossRef
6.
Zurück zum Zitat Scopinaro N (2014) Bariatric metabolic surgery. Rozhl Chir 93:404–415PubMed Scopinaro N (2014) Bariatric metabolic surgery. Rozhl Chir 93:404–415PubMed
7.
Zurück zum Zitat Blanco DG, Funes DR, Giambartolomei G, Lo Menzo E, Szomstein S, Rosenthal RJ (2019) Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass in cardiovascular risk reduction: a match control study. Surg Obes Relat Dis 15:14–20CrossRef Blanco DG, Funes DR, Giambartolomei G, Lo Menzo E, Szomstein S, Rosenthal RJ (2019) Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass in cardiovascular risk reduction: a match control study. Surg Obes Relat Dis 15:14–20CrossRef
8.
Zurück zum Zitat Huang CC, Wang W, Chen RJ, Wei PL, Tzao C, Chen PL (2018) Predicted coronary heart disease risk decreases in obese patients after laparoscopic sleeve gastrectomy. World J Surg 42:2173–2182CrossRef Huang CC, Wang W, Chen RJ, Wei PL, Tzao C, Chen PL (2018) Predicted coronary heart disease risk decreases in obese patients after laparoscopic sleeve gastrectomy. World J Surg 42:2173–2182CrossRef
9.
Zurück zum Zitat Chiu CC, Wang JJ, Tsai TC, Chu CC, Shi HY (2012) The relationship between volume and outcome after bariatric surgery: a nationwide study in Taiwan. Obes Surg 22:1008–1015CrossRef Chiu CC, Wang JJ, Tsai TC, Chu CC, Shi HY (2012) The relationship between volume and outcome after bariatric surgery: a nationwide study in Taiwan. Obes Surg 22:1008–1015CrossRef
10.
Zurück zum Zitat Huang CC, Huang YT, Chiu CC (2015) A population-based analysis of use and outcomes of laparoscopic bariatric surgery across socioeconomic groups in Taiwan. Int J Equity Health 14:127CrossRef Huang CC, Huang YT, Chiu CC (2015) A population-based analysis of use and outcomes of laparoscopic bariatric surgery across socioeconomic groups in Taiwan. Int J Equity Health 14:127CrossRef
11.
Zurück zum Zitat Chen JH, Tsai MS, Chen CY, Lee HM, Cheng CF, Chiu YT, Yin WY, Lee CH (2019) Bariatric surgery did not increase the risk of gallstone disease in obese patients: a comprehensive cohort study. Obes Surg 29:464–473CrossRef Chen JH, Tsai MS, Chen CY, Lee HM, Cheng CF, Chiu YT, Yin WY, Lee CH (2019) Bariatric surgery did not increase the risk of gallstone disease in obese patients: a comprehensive cohort study. Obes Surg 29:464–473CrossRef
12.
Zurück zum Zitat Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251CrossRef Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251CrossRef
13.
Zurück zum Zitat Rashid M, Kwok CS, Gale CP, Doherty P, Olier I, Sperrin M, Kontopantelis E, Peat G, Mamas MA (2017) Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 3:20–36CrossRef Rashid M, Kwok CS, Gale CP, Doherty P, Olier I, Sperrin M, Kontopantelis E, Peat G, Mamas MA (2017) Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 3:20–36CrossRef
14.
Zurück zum Zitat Sjostrom L, Peltonen M, Jacobson P et al (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307:56–65CrossRef Sjostrom L, Peltonen M, Jacobson P et al (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307:56–65CrossRef
15.
Zurück zum Zitat Liang TJ, Liu SI, Chen YC, Chang PM, Huang WC, Chang HT, Chen IS (2017) Analysis of gallstone disease after gastric cancer surgery. Gastric Cancer 20:895–903CrossRef Liang TJ, Liu SI, Chen YC, Chang PM, Huang WC, Chang HT, Chen IS (2017) Analysis of gallstone disease after gastric cancer surgery. Gastric Cancer 20:895–903CrossRef
16.
Zurück zum Zitat Gupta PK, Gupta H, Kaushik M, Fang X, Miller WJ, Morrow LE, Armour-Forse R (2012) Predictors of pulmonary complications after bariatric surgery. Surg Obes Relat Dis 8:574–581CrossRef Gupta PK, Gupta H, Kaushik M, Fang X, Miller WJ, Morrow LE, Armour-Forse R (2012) Predictors of pulmonary complications after bariatric surgery. Surg Obes Relat Dis 8:574–581CrossRef
17.
Zurück zum Zitat Smith MD, Patterson E, Wahed AS, Belle SH, Berk PD, Courcoulas AP, Dakin GF, Flum DR, Machado L, Mitchell JE, Pender J, Pomp A, Pories W, Ramanathan R, Schrope B, Staten M, Ude A, Wolfe BM (2011) Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg 21:1687–1692CrossRef Smith MD, Patterson E, Wahed AS, Belle SH, Berk PD, Courcoulas AP, Dakin GF, Flum DR, Machado L, Mitchell JE, Pender J, Pomp A, Pories W, Ramanathan R, Schrope B, Staten M, Ude A, Wolfe BM (2011) Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg 21:1687–1692CrossRef
18.
Zurück zum Zitat Capoccia D, Coccia F, Guarisco G, Testa M, Rendina R, Abbatini F, Silecchia G, Leonetti F (2018) Long-term metabolic effects of laparoscopic sleeve gastrectomy. Obes Surg 28:2289–2296CrossRef Capoccia D, Coccia F, Guarisco G, Testa M, Rendina R, Abbatini F, Silecchia G, Leonetti F (2018) Long-term metabolic effects of laparoscopic sleeve gastrectomy. Obes Surg 28:2289–2296CrossRef
19.
Zurück zum Zitat Wadden TA, Webb VL, Moran CH, Bailer BA (2012) Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation 125:1157–1170CrossRef Wadden TA, Webb VL, Moran CH, Bailer BA (2012) Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation 125:1157–1170CrossRef
20.
Zurück zum Zitat Wadden TA, Tronieri JS, Butryn ML (2020) Lifestyle modification approaches for the treatment of obesity in adults. Am Psychol 75:235–251CrossRef Wadden TA, Tronieri JS, Butryn ML (2020) Lifestyle modification approaches for the treatment of obesity in adults. Am Psychol 75:235–251CrossRef
21.
Zurück zum Zitat Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L (2004) XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27:155–161CrossRef Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L (2004) XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27:155–161CrossRef
22.
Zurück zum Zitat Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, Lau DC, le Roux CW, Violante Ortiz R, Jensen CB, Wilding JP, SCALE Obesity and Prediabetes NN8022-1839 Study Group (2015) A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med 373:11–22CrossRef Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, Lau DC, le Roux CW, Violante Ortiz R, Jensen CB, Wilding JP, SCALE Obesity and Prediabetes NN8022-1839 Study Group (2015) A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med 373:11–22CrossRef
23.
Zurück zum Zitat Patkar A, Fegelman E, Kashyap SR et al (2017) Assessing the real-world effect of laparoscopic bariatric surgery on the management of obesity-related comorbidities: a retrospective matched cohort study using a US Claims Database. Diabetes Obes Metab 19:181–188CrossRef Patkar A, Fegelman E, Kashyap SR et al (2017) Assessing the real-world effect of laparoscopic bariatric surgery on the management of obesity-related comorbidities: a retrospective matched cohort study using a US Claims Database. Diabetes Obes Metab 19:181–188CrossRef
24.
Zurück zum Zitat Ionut V, Burch M, Youdim A, Bergman RN (2013) Gastrointestinal hormones and bariatric surgery-induced weight loss. Obesity (Silver Spring) 21:1093–1103CrossRef Ionut V, Burch M, Youdim A, Bergman RN (2013) Gastrointestinal hormones and bariatric surgery-induced weight loss. Obesity (Silver Spring) 21:1093–1103CrossRef
25.
Zurück zum Zitat Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, Montori VM (2007) Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 49:403–414CrossRef Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK, Montori VM (2007) Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 49:403–414CrossRef
26.
Zurück zum Zitat Carlsson LMS, Sjöholm K, Karlsson C, Jacobson P, Andersson-Assarsson JC, Svensson PA, Larsson I, Hjorth S, Neovius M, Taube M, Carlsson B, Peltonen M (2017) Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycaemic status: a post-hoc analysis of participants from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol 5:271–279CrossRef Carlsson LMS, Sjöholm K, Karlsson C, Jacobson P, Andersson-Assarsson JC, Svensson PA, Larsson I, Hjorth S, Neovius M, Taube M, Carlsson B, Peltonen M (2017) Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycaemic status: a post-hoc analysis of participants from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol 5:271–279CrossRef
27.
Zurück zum Zitat Carlsson LM, Peltonen M, Ahlin S et al (2012) Bariatric surgery and prevention of type 2 diabetes in Swedish Obese Subjects. N Engl J Med 367:695–704CrossRef Carlsson LM, Peltonen M, Ahlin S et al (2012) Bariatric surgery and prevention of type 2 diabetes in Swedish Obese Subjects. N Engl J Med 367:695–704CrossRef
28.
Zurück zum Zitat Sjostrom L, Narbro K, Sjostrom CD et al (2007) Effects of bariatric surgery on mortality in Swedish Obese Subjects. N Engl J Med 357:741–752CrossRef Sjostrom L, Narbro K, Sjostrom CD et al (2007) Effects of bariatric surgery on mortality in Swedish Obese Subjects. N Engl J Med 357:741–752CrossRef
30.
Zurück zum Zitat Dhalwani NN, Zaccardi F, Waheed H, Mytton J, Papamargaritis D, Webb DR, Evison F, Lilford R, Davies MJ, Khunti K (2019) Cardiovascular, cancer and mortality events after bariatric surgery in people with and without pre-existing diabetes: a nationwide study. J Diabetes 11:265–272CrossRef Dhalwani NN, Zaccardi F, Waheed H, Mytton J, Papamargaritis D, Webb DR, Evison F, Lilford R, Davies MJ, Khunti K (2019) Cardiovascular, cancer and mortality events after bariatric surgery in people with and without pre-existing diabetes: a nationwide study. J Diabetes 11:265–272CrossRef
31.
Zurück zum Zitat Khorgami Z, Jackson TN, Aminian A, Sahawneh JM, Sclabas GM, Chow GS (2019) Early cardiac complications after bariatric surgery: does the type of procedure matter? Surg Obes Relat Dis 15:1132–1137CrossRef Khorgami Z, Jackson TN, Aminian A, Sahawneh JM, Sclabas GM, Chow GS (2019) Early cardiac complications after bariatric surgery: does the type of procedure matter? Surg Obes Relat Dis 15:1132–1137CrossRef
33.
Zurück zum Zitat Lee WJ, Wang W (2015) Bariatric surgery: Asia-Pacific perspective. Obes Surg 15:751–757CrossRef Lee WJ, Wang W (2015) Bariatric surgery: Asia-Pacific perspective. Obes Surg 15:751–757CrossRef
34.
Zurück zum Zitat Mingrone G, Panunzi S, De Gaetano A et al (2015) Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 386:964–973CrossRef Mingrone G, Panunzi S, De Gaetano A et al (2015) Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 386:964–973CrossRef
35.
Zurück zum Zitat Cheng J, Gao J, Shuai X, Wang G, Tao K (2016) The comprehensive summary of surgical versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. Oncotarget 7:39216–39230CrossRef Cheng J, Gao J, Shuai X, Wang G, Tao K (2016) The comprehensive summary of surgical versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. Oncotarget 7:39216–39230CrossRef
Metadaten
Titel
The long-term risk of cardiovascular events in patients following bariatric surgery compared to a non-surgical population with obesity and the general population: a comprehensive national cohort study
verfasst von
Shao-Lun Hung
Chung-Yen Chen
Wei-Leng Chin
Cheng-Hung Lee
Jian-Han Chen
Publikationsdatum
10.11.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 1/2021
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-020-02027-2

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