Cardiovascular, cancer and mortality events after bariatric surgery in people with and without pre-existing diabetes: A nationwide study.

BACKGROUND

Bariatric surgery reduces cardiovascular events and mortality risk in obese individuals. However, it is unclear whether diabetes modifies this effect. This study examined mortality, cardiovascular, and cancer risk following bariatric surgery in adults with and without pre-existing diabetes.

METHODS

Using mortality-linked Hospital Episodes Statistics (2006-14) from England, the risk of death, myocardial infarction, stroke, unstable angina, heart failure, and cancer following bariatric surgery was examined; the risk of death in people undergoing surgery was also compared with mortality rates of the general population.

RESULTS

Of the 35 887 people undergoing bariatric surgery, 9175 (25.6%) had pre-existing diabetes. During a mean follow-up of 5.3 years, 801 people died, of whom 293 (36.6%) had pre-existing diabetes. The risk of all-cause mortality was 26% higher in people with than without diabetes (adjusted hazard ratio [aHR] 1.26, 95% confidence interval [CI] 1.08-1.46), whereas the risk of cancer was 21% higher (aHR 1.21; 95% CI 1.14-1.77). The risk of cardiovascular events was higher for patients with than without diabetes (aHRs [95% CIs] 2.08 [1.42-3.05], 1.80 [1.29-2.52], 1.61 [1.18-2.19], and 1.42 [1.14-1.77] for myocardial infarction, unstable angina, stroke, and heart failure, respectively). Compared with the general population, the age-standardized mortality rate ratio was 1.70 (1.52-1.91) and 1.35 (1.23-1.48) in people with and without pre-existing diabetes, respectively.

CONCLUSIONS

For patients with pre-existing diabetes, the risk of death, cardiovascular events, and cancer after bariatric surgery was higher than for those without diabetes, whose mortality risk after surgery remains 35% higher than that of the general population.

摘要: 背景 减肥手术(bariatric surgery)可降低肥胖患者的心血管事件以及死亡的风险。然而,  目前尚未明确糖尿病是否会影响这种效果。这项研究在既往存在或者不存在糖尿病的成年患者中调查了减肥手术后的死亡率、心血管事件以及癌症的风险。 方法 使用(2006-14)英格兰医院死亡事件相关的统计数据库调查了减肥手术后的死亡、心肌梗死、卒中、不稳定型心绞痛、心力衰竭以及癌症的风险;还比较了手术患者的死亡风险与普通人群的死亡率。 结果 在35887名接受减肥手术的患者中,  有9175名(25.6%)既往存在糖尿病。在平均5.3年的随访期间,  有801名患者死亡,  其中293名(36.6%)既往存在糖尿病。合并与未合并糖尿病的患者相比,  全因死亡的风险要高26%(校正后的危险比[aHR]为1.26,95%置信区间[CI]为1.08-1.46),而癌症的风险要高21%(aHR为1.21;95% CI为1.14-1.77)。合并与未合并糖尿病的患者相比,  心血管事件的风险更高(心肌梗死、不稳定心绞痛、卒中与心力衰竭的aHRs [95% CIs]分别为2.08 [1.42-3.05]、1.80 [1.29-2.52]、1.61 [1.18-2.19]与1.42 [1.14-1.77])。与普通人群相比,  既往存在或者不存在糖尿病的患者的年龄标准化死亡率危险比分别为1.70(1.52-1.91)与1.35(1.23-1.48)。 结论 既往存在糖尿病的患者与不存在糖尿病的患者相比减肥手术之后的死亡率、心血管事件以及癌症的风险都更高,  他们手术之后的死亡风险与普通人群相比仍然要高35%。.

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© 2018 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.