Bariatric surgery and its impact on cardiovascular disease and mortality: A systematic review and meta-analysis

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:173

Article

Kwok, Chun Shing¹  Pradhan, Ashish²  Khan, Muhammad A.¹  Anderson, Simon G.¹  Keavney, Bernard D.¹  Myint, Phyo Kyaw³  Mamas, Mamas A.¹  Loke, Yoon K.⁴ 

[1] Univ Manchester, Cardiovasc Inst, Manchester M13 9WL, Lancs, England

[2] Royal Preston Hosp, Preston, Lancs, England

[3] Univ Aberdeen, Sch Med & Dent, Aberdeen, Scotland

[4] Univ E Anglia, Norwich Med Sch, Norwich NR4 7TJ, Norfolk, England

关键词: Obesity;    Bariatric surgery;    Cardiovascular disease;    Myocardial infarction;    Stroke;    Mortality;   

DOI  :  10.1016/j.ijcard.2014.02.026

来源: Elsevier

【 摘 要 】

Background: Bariatric surgery has been shown to improve cardiovascular risk factors but long term benefits for survival and cardiovascular events are still uncertain. Methods: We searched MEDLINE and EMBASE for parallel group studies that evaluated the clinical outcomes associated with bariatric surgery as compared to non-surgical treatment. Relevant studies were pooled using random effects meta-analysis for risk of myocardial infarction, stroke, cardiovascular events and mortality. Results: 14 studies met the inclusion criteria, which included 29,208 patients who underwent bariatric surgery and 166,200 nonsurgical controls (mean age 48 years, 30% male, follow up period ranged from 2 years to 14.7 years). Four studies were considered at moderate-high risk of bias, whilst ten studies were at moderate or lower risk of bias. Compared to nonsurgical controls there was more than 50% reduction in mortality amongst patients who had bariatric surgery (OR 0.48 95% CI 0.35-0.64, I-2 = 86%, 14 studies). In pooled analysis of four studies with adjusted data, bariatric surgery was associated with a significantly reduced risk of composite cardiovascular adverse events (OR 0.54 95% CI 0.41-0.70, I-2 = 58%). Bariatric surgery was also associated with significant reduction in specific endpoints of myocardial infarction (OR 0.46 95% CI 0.30-0.69, I-2 = 79%, 4 studies) and stroke (OR 0.49 95% CI 0.32-0.75, I-2 = 59%, 4 studies). Conclusions: Data from observational studies indicates that patients undergoing bariatric surgery have a reduced risk of myocardial infarction, stroke, cardiovascular events and mortality compared to non-surgical controls. Future randomized studies should investigate whether these observations are reproduced in a clinical trials setting. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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