Long-term mortality and incidence of cardiovascular diseases and type 2 diabetes in diabetic and nondiabetic obese patients undergoing gastric banding: a controlled study

Cardiovascular Diabetology

Original Investigation

Alberto Morabito¹  Giancarlo Micheletto²  Enrico Mozzi³  Antonio E. Pontiroli⁴  Ahmed S. Zakaria⁵  Ermanno Mantegazza⁵  Alessandro Saibene⁶ 

[1] Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy;Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy;Istituto Clinico Sant Ambrogio, Milan, Italy;Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy;Ospedale Policlinico, Milan, Italy;Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy;Ospedale San Paolo, Milan, Italy;Ospedale San Paolo, Milan, Italy;Ospedale San Raffaele, Milan, Italy;

关键词: Bariatric surgery;    Survival;    Adjustable gastric banding;    Diabetes mellitus;    Cardiovascular disease;    Exemptions;    Hospital admissions;    Obesity;    Mortality;    Prevention of diabetes;    Prevention of cardiovascular disease;    ICD10;    Kaplan–Meier;    Cox proportional hazards model;   

DOI  :  10.1186/s12933-016-0347-z

 received in 2015-11-18, accepted in 2016-01-26,  发布年份 2016

来源: Springer

【 摘 要 】

Background and aimAim of this retrospective study was to compare long-term mortality and incidence of new diseases [diabetes and cardiovascular (CV) disease] in morbidly obese diabetic and nondiabetic patients, undergoing gastric banding (LAGB) in comparison to medical treatment.Patients and methodsMedical records of obese patients [body mass index (BMI) > 35 kg/m2 undergoing LAGB (n = 385; 52 with diabetes) or medical treatment (controls, n = 681; 127 with diabetes), during the period 1995–2001 (visit 1)] were collected. Patients were matched for age, sex, BMI, and blood pressure. Identification codes of patients were entered in the Italian National Health System Lumbardy database, that contains life status, causes of death, as well as exemptions, drug prescriptions, and hospital admissions (proxies of diseases) from visit 1 to September 2012. Survival was compared across LAGB patients and matched controls using Kaplan–Meier plots adjusted Cox regression analyses.ResultsObservation period was 13.9 ± 1.87 (mean ± SD). Mortality rate was 2.6, 6.6, and 10.1 % in controls at 5, 10, and 15 years, respectively; mortality rate was 0.8, 2.5, and 3.1 % in LAGB patients at 5, 10, and 15 years, respectively. Compared to controls, surgery was associated with reduced mortality [HR 0.35, 95 % CI 0.19–0.65, p < 0.001 at univariate analysis, HR 0.41, 95 % CI 0.21–0.76, p < 0.005 at adjusted analysis], similar in diabetic [HR 0.34, 95 % CI 0.13–0.87, p = 0.025] and nondiabetic [HR 0.42, 95 % CI 0.19–0.97, p = 0.041] patients. Surgery was also associated with lower incidence of diabetes (15 vs 48 cases, p = 0.035) and CV diseases (52 vs 124 cases, p = 0.048), and of hospital admissions (88 vs 197, p = 0.04).ConclusionUp to 17 years, gastric banding is associated with reduced mortality in diabetic and nondiabetic patients, and with reduced incidence of diabetes and cardiovascular diseases.

【 授权许可】

CC BY   
© Pontiroli et al. 2016