Effects of OAGB surgery on cardiovascular and cerebrovascular risk in patients with obesity and diabetes mellitus

doi:10.3877/cma.j.issn.2095-9605.2023.02.008

Abstract

Abstract:

Objective

In order to objectively evaluate the benefits of long-term coronary heart disease (CHD) and stroke in obese and diabetic patients, the changes of UK diabetes cardiovascular disease risk factors (UKPDS) before and after One-anastomosis gastric bypass were investigated.

Methods

Data of this study are obtained from the bariatric/metabolic surgical center of Suzhou Benq Hospital. A total of 30 patients with obesity and diabetes, including 15 patients in type 2 diabetic mellitus (T2DM) group and 15 patients in obesity group, were enrolled from September 2019 to june 2020. UKPDS was used to assess changes in cardiovascular risk factors before and after surgery. All patients aged 18 to 60 years were obese (BMI>32.5 kg/m²), and metabolic surgery was performed by laparoscopic one single anastomotic gastric bypass (OAGB). SPSS 25 was used for statistical analysis.

Results

6 months after surgery, the risks of coronary heart disease (CHD) and Stroke were decreased in both groups (P<0.05). There was some improvement in the incidence of CHD, Fatal CHD, Stroke, and Fatal Stroke after surgery (P<0.05 in both groups). Fatal CHD and Fatal Stroke decreased significantly in the obesity group (0.8±1.2 vs. 0.4±0.9; P=0.008 and 0.1±0.2 vs. 0.05±0.13, P=0.027), while CHD and Fatal CHD decreased more significantly in the diabetic group(8.28±5.28 vs. 4.07±2.86, P<0.001 and 3.5±2.79 vs. 1.28±1.18, P=0.001),

Conclusions

Metabolic surgery can effectively reduce the risk of long-term cardiovascular and cerebrovascular diseases in obese and diabetic patients, and obese patients with T2DM have more benefits, so early metabolic surgery is recommended for obese patients with T2DM.

Key words: Bariatricmetabolic surgery, One-anastomosis gastric bypass, United Kingdom Prospective Diabetes Study, Type 2 Diabetic Mellitus, Obesity

Xiaoguang Qin, Zhongqi Mao, Xiaoqing Zhou, Erfan Xie, Guoqiang Wu, Min Zhang, Weijie Lee. Effects of OAGB surgery on cardiovascular and cerebrovascular risk in patients with obesity and diabetes mellitus[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(02): 120-125.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfpydxbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9605.2023.02.008

https://zhfpydxbdzzz.cma-cmc.com.cn/EN/Y2023/V09/I02/120

Figures/Tables 3

References 29

[1]	Vogel B, Acevedo M, Appelman Y, et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030 [J]. Lancet, 2021, 397(10292): 2385-2438.
[2]	Scopinaro N. The IFSO and obesity surgery throughout the world [J]. Obesity Surgery, 1998, 8(1): 3-8.
[3]	Buchwald H, Oien DM. Metabolic / Bariatric surgery worldwide 2008 [J]. Obesity Surgery, 2009, 19(12): 1605-1611.
[4]	Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013 [J]. Obesity Surgery, 2015, 25(10):1822-1832.
[5]	Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014 [J]. Obesity Surgery, 2017, 27(9): 1-11.
[6]	Maurizio DL, Tiffany T, Geraldine O, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSOposition statement [J]. Obesity Surgery, 2018, 28(5): 1188-1206.
[7]	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南(2019版) [J]. 中国实用外科杂志, 2019, 39(4): 301-306.
[8]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会,中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库：2021年度报告 [J/CD]. 中华肥胖与代谢病电子杂志, 2022, 8(1): 15-23.
[9]	Han Zhe, Wang Yang, Li Jing. Effects of Atorvastatin Combined with Nano-Selenium on Blood Lipids and Oxidative Stress in Atherosclerotic Rats [J]. J Nanosci Nanotechnol, 2021, 21(2): 1331-1337.
[10]	Lee WJ, Chong K, Lin YH, et al. Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect [J]. Obes Surg, 2014, 24(9): 1552-62.
[11]	Wu WC, Lee WJ, Lee TH, et al. Do different bariatric surgical procedures influence plasma levels of matrix metalloproteinase-2, -7, and-9 among patients with type 2 diabetes mellitus? [J]. World J Diabetes, 2020, 11(6): 252-260.
[12]	Khoraki J, Campos GM. Comment on:Predictors of diabetes relapse after metabolic surgery in Asia [J]. Surgery for Obesity and Related Diseases, 2022, 18(4): 461-463.
[13]	Aminian A, Wilson R, Zajichek A, et al. Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity: Comparison of Gastric Bypass, Sleeve Gastrectomy, and Usual Care [J]. Diabetes Care, 2021, 44(11): 2552-2563.
[14]	Buchwald H,Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis [J]. Acc Current Journal Review, 2004, 14(14): 13-13.
[15]	Jones AR, Tovee MJ, Cutler LR, et al. Health effects of overweight and obesity in 195 Countries over 25 Years [J]. Yearbook of Paediatric Endocrinology, 2018, 377(1): 13-27.
[16]	Pournaras DJ, Welbourn R. Weight loss surgery and cardiovascular risk and mortality in patients with type 2 diabetes [J]. Lancet Diabetes Endocrinol, 2015, 3(11): 828-829.
[17]	Sjostrom L. Long-Term Mortality after Gastric Bypass Surgery—NEJM. 2007. 4 - 6. Print.
[18]	Benraouane F, Litwin SE. Reductions in cardiovascular risk after bariatric surgery [J]. Current Opinion in Cardiology, 2011, 26(6): 555.
[19]	Lars S, Markku P, Peter J, et al. Bariatric Surgery and Long-term Cardiovascular Events [J]. Jama, 2012, 307(1): 56-65.
[20]	Eliasson B, Liakopoulos V, Franzén S, et al. Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: a nationwide, matched, observational cohort study [J]. Lancet Diabetes Endocrinol, 2015, 3(11): 847-854.
[21]	Lakdawala M, Shaikh S, Bandukwala S, et al. Roux-en-Y gastric bypass stands the test of time: 5-year results in low body mass index (30-35 kg/m²) Indian patients with type 2 diabetes mellitus [J]. Surgery for Obesity & Related Diseases, 2013, 9(3): 370-378.
[22]	Hsu CC, Almulaifi A, Chen JC, et al. Effect of Bariatric Surgery vs Medical Treatment on Type 2 Diabetes in Patients With Body Mass Index Lower Than 35: Five-Year Outcomes [J]. Jama Surgery, 2015, 150(12): 1.
[23]	LGenser, CB. Bariatric surgery versus intensive medical therapy for diabetes -5- year outcomes [J]. Obésité, 2017, 376(7): 641-651.
[24]	Ikramuddin S, Korner J, Wei JL, et al. Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin A1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study [J]. JAMA, 2018, 319(3): 266.
[25]	Cohen RV, Pinheiro JC, Schiavon CA , et al. Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity [J]. Diabetes care, 2012, 35(7): 1420-1428.
[26]	Aung L, Lee WJ, Chen SC, et al. Bariatric surgery for patients with early-onset vs late-onset type 2 diabetes [J]. Jama Surg, 2016, 151(9): 798-805.
[27]	Olbers T, Beamish AJ, Gronowitz E, et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study [J]. Lancet Diabetes & Endocrinology, 2017, 5(3): 174-183.
[28]	Angrisani L, Santonicola A,Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014 [J]. Obesity Surgery, 2017, 27(9): 1-11.
[29]	Wei JH, Chou RH, Huang PH, et al. Metabolic surgery ameliorates cardiovascular risk in obese diabetic patients: Influence of different surgical procedures [J]. Surgery for Obesity and Related Diseases, 2018, 14(12): 1832-1840.

时间	例数	年龄（年）	T2DM持续时间（年）	女性%	收缩压（mmHg）	糖化血红蛋白（%）	BMI（kg/m²）	总胆固醇（mmol/L）	高密度脂蛋白（mmol/L）	吸烟史	房颤（%）
术前	30	37.7±8.0	1.6±2.2	25（83%）	139.1±17.6	6.7±1.5	35.8±3.9	5.1±1.0	1.1±0.3	9 （30%）	0（0%）
术后	30				116.3 ±11.7	5.3±0.8	26.0 ±3.5	4.4±0.7	1.2±0.3	8（27%）	0（0%）
P值					<0.001*	<0.001*	<0.001*	<0.001*	0.062	0.326

时间	例数	年龄（年）	T2DM持续时间（年）	女性%	收缩压（mmHg）	糖化血红蛋白（%）	BMI（kg/m²）	总胆固醇（mmol/L）	高密度脂蛋白（mmol/L）	吸烟史	房颤（%）
术前	30	37.7±8.0	1.6±2.2	25（83%）	139.1±17.6	6.7±1.5	35.8±3.9	5.1±1.0	1.1±0.3	9 （30%）	0（0%）
术后	30				116.3 ±11.7	5.3±0.8	26.0 ±3.5	4.4±0.7	1.2±0.3	8（27%）	0（0%）
P值					<0.001*	<0.001*	<0.001*	<0.001*	0.062	0.326

组别	时间	年龄（年）	性别比例（女：男）	BMI（kg/m²）	收缩压（mmHg）	糖化血红蛋白（%）	总胆固醇（mmol/L）	高密度脂蛋白（mmol/L）	T2DM持续时间（年）	吸烟史（%）
糖尿病组	术前	41.1±6.7	2.75	35.3±4.1	145.3±16.5	7.6±1.5	5.0±1.0	0.98±0.17	3.1±2.2	4（27%）
	术后	41.7±6.7	2.75	26.1±3.1	120.8±10.5	5.58±0.95	4.25±0.51	1.10±0.31	3.7±2.2	4（27%）
	P¹			<0.001*	<0.001*	<0.001*	0.008	0.094
单纯肥胖组	术前	34.2±7.7	14	36.3±3.7	132.9±16.4	5.7±0.5	5.1±1.0	1.2±0.3	0	5（33%）
	术后	34.8±7.7	14	25.7±4.0	111.8±11.8	5.02±0.44	4.6±0.77	1.30±0.33	0	4（27%）
	P²			<0.001*	<0.001*	<0.001*	0.004	0.309

组别	时间	年龄（年）	性别比例（女：男）	BMI（kg/m²）	收缩压（mmHg）	糖化血红蛋白（%）	总胆固醇（mmol/L）	高密度脂蛋白（mmol/L）	T2DM持续时间（年）	吸烟史（%）
糖尿病组	术前	41.1±6.7	2.75	35.3±4.1	145.3±16.5	7.6±1.5	5.0±1.0	0.98±0.17	3.1±2.2	4（27%）
	术后	41.7±6.7	2.75	26.1±3.1	120.8±10.5	5.58±0.95	4.25±0.51	1.10±0.31	3.7±2.2	4（27%）
	P¹			<0.001*	<0.001*	<0.001*	0.008	0.094
单纯肥胖组	术前	34.2±7.7	14	36.3±3.7	132.9±16.4	5.7±0.5	5.1±1.0	1.2±0.3	0	5（33%）
	术后	34.8±7.7	14	25.7±4.0	111.8±11.8	5.02±0.44	4.6±0.77	1.30±0.33	0	4（27%）
	P²			<0.001*	<0.001*	<0.001*	0.004	0.309

组别	时间	10年CHD的发病风险（%）	10年Fatal CHD的发病风险（%）	10年stroke的发病风险（%）	10年Fatal stroke的发病风险（%）
患者总和	术前	5.54±4.89	2.15±2.54	1.13±1.19	0.19±0.25
	术后	2.9±2.64	0.88±1.11	0.83±0.88	0.1±0.14
	下降程度	2.55（46%）	1.27 （59.1%）	0.3 （26.5%）	0.06 （31.5%）
	P	<0.001*	<0.001*	<0.001*	0.001
单纯肥胖组（n=15）	术前	2.8±2.3	0.8±1.2	0.6±0.8	0.1±0.2
	术后	1.9±1.9	0.4±0.9	0.5±0.6	0.05±0.13
	下降程度	0.9（32.1%）	0.4（50.0%）	0.1（17%）	0.05（50%）
	P	0.002	0.008	0.017	0.027
糖尿病组（n=15）	术前	8.28±5.28	3.5±2.79	1.63±1.31	0.29±0.27
	术后	4.07±2.86	1.28±1.18	1.17±0.97	0.16±0.15
	下降程度	4.21（50.8%）	2.22（63%）	0.46（28%）	0.13 （45%）
	P	<0.001*	0.001	0.002	0.006
单纯肥胖组与糖尿病组对比	P¹	0.024	0.047	0.040	0.043

Please choose a citation manager

Content to export