"Cycle": Fill the gap!

Recently, a research team led by Mehran Anvari, professor of surgery at McMaster University in Canada, published an important research result in the Journal of the American Heart Association [1].

They found that for obese patients with heart disease or heart failure, metabolic surgery can reduce the risk of major cardiovascular adverse events (MACE, disease attack, stroke, heart failure, and overall mortality) by 42%.

In addition, it is worth mentioning that metabolic surgery is associated with a 50% reduction in the risk of all-cause death in these patients.

The results of this study indicate that metabolic surgery may become an intervention for patients with ischemic heart disease or heart failure combined with obesity.

▲ Screenshot of the homepage of the paper.
The hazard of obesity to the human body is really great.

For cardiovascular and cerebrovascular diseases alone, obesity is associated with increased incidence of heart failure (HF), myocardial infarction (MI), stroke, and even death.

Weight loss has become the standard treatment recommendation for patients with cardiovascular disease (CVD) and obesity.

Although clinicians all recommend this, in fact, the data from randomized clinical studies supporting this recommendation are limited.

For example, the largest study of people with type 2 diabetes with overweight published in 2013, failed to reach a result that weight loss significantly reduces the incidence and mortality of cardiovascular diseases [2].

However, the weight loss method used in this study is relatively mild, and patients did not lose a lot of weight; therefore, whether a greater degree of weight loss can reduce the risk of cardiovascular disease and the risk of death is still inconclusive.

Although the relationship between obesity and cardiovascular disease is still unclear, the weight loss effect of metabolic surgery is very clear, and related clinical studies have also shown that metabolic surgery may also be beneficial to cardiovascular disease [3].

There have been randomized controlled studies showing that bariatric surgery can improve diabetes outcomes and cardiovascular disease-related risk factors in diabetic and severely obese patients [4-6].
Unfortunately, such studies have not evaluated the effects of metabolic surgery on mortality and other risk factors.
The impact of the MACE ending.

Two recent retrospective studies have shown that [7, 8], after 8 years of metabolic surgery (sleeve gastrectomy and Roux-en-Y gastric bypass surgery) in diabetic patients, the incidence of MACE is significantly reduced.

However, these previous studies still have shortcomings, and there is not enough evidence to support that metabolic surgery can reduce the risk of MACE in obese patients with heart disease or heart failure.

To be more direct, this field is still blank.

▲ The picture was published by Debora Alves on Pixabay.
Next, let's take a look at the main research results of this study.

First, this is a retrospective study of a population-based matched cohort.

Patients in the metabolic surgery group completed bariatric surgery in Ontario between January 2010 and December 2016 (more than 80% of metabolic surgery was Roux-en-Y gastric bypass).

The data for non-surgical patients comes from the Ontario Electronic Medical Record Management Connected Database (EMRALD).

The main outcome observed in this study is the expansion of MACE (including the first occurrence of all-cause mortality, myocardial infarction, coronary artery bypass graft, coronary artery replasty, stroke or hospitalization due to heart failure) events; the secondary outcome is myocardial infarction , Stroke and all-cause mortality.

▲ Test flow chart From January 2010 to December 2016, 1,319 patients in the metabolic surgery group and the non-surgical group were each included in the study.
The overall average age was 56.
0 years (61% were women), and the average BMI was 47.
4.

Among them, 548 (274 in the surgical group and 274 in the non-surgical group) had a history of heart failure (HF), and the rest had a history of ischemic heart disease (IHD).

There was no difference in the revascularization rate between the two groups.

During a median follow-up of 4.
5 years, a total of 410 patients had a major outcome event.

Among them, there were 151 cases (11.
5%) in the operation group and 259 cases (19.
6%) in the control group.
The adjusted HR was 0.
58, which is beneficial to the operation group.

This means that metabolic surgery reduces the risk of major adverse cardiovascular events in such patients by 42%.

▲The relationship between metabolic surgery and the main outcome In the subgroup of IHD patients (n = 2403), metabolic surgery was associated with a 40% reduction in the incidence of the main outcome; in the subgroup of HF patients (n = 2403), metabolic surgery was related to the main outcome.
A 56% reduction in the incidence of outcomes is associated.

In addition, a total of 280 patients had secondary outcomes, including 107 cases (8.
1%) in the surgery group and 173 cases (13.
1%) in the control group.

This means that during a median follow-up of 4.
7 years, metabolic surgery was associated with a 34% reduction in the incidence of secondary outcomes.

Specific to the subgroup, the IHD subgroup was reduced by 33%, and the HF subgroup was 60%.

The study also conducted a stratified analysis based on gender, BMI, and age.

In general, the risk of the main outcome of patients aged ≥ 60 years was reduced by 41%, and there was no significant difference in the impact of metabolic surgery on the main outcome of different genders and different BMIs.

In addition, metabolic surgery is associated with a 50% reduction in the risk of all-cause death, a 65% reduction in the risk of cardiovascular disease, and a 44% reduction in the risk of other deaths.

▲ In the entire cohort, IHD and HF subgroups, the relationship between metabolic surgery and mortality is the safety of surgery.

The researchers found that the total complication rate for 30 days was 7.
7% and the total mortality rate was 0.
15%.

The median postoperative hospital stay was 3 days, and 3.
5% of patients would enter the ICU.

In addition, 6 patients had myocardial infarction, and 5 patients underwent secondary operations.

Overall, this study shows that metabolic surgery may become an effective intervention for patients with ischemic heart disease or heart failure in the near future.

Of course, the results of this study need to be verified by a large randomized controlled trial.

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Fisher DP, Johnson E, Haneuse S, et al.
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Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity.
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14231 Author of this articleResponsible editor of Qing TinaBioTalker