Effect of bariatric surgery versus medical therapy on long-term cardiovascular risk in low BMI Chinese patients with type 2 diabetes: a propensity score-matched analysis |
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| Institution: | 1. Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China;2. Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension Chongqing, China;1. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan;2. Center for Obesity, Life Style, and Metabolic Surgery, National Taiwan University Hospital, Taipei, Taiwan;3. Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan;4. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;5. Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;6. Metabolic and Weight Management Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;7. Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan;8. Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan;1. Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany;2. Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Heidelberg University Hospital, Heidelberg, Germany;3. Department of Endocrinology and Metabolism, Heidelberg University Hospital, Heidelberg, Germany;4. Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany;5. Department of Gastroenterology, Infectious Diseases and Intoxication, Heidelberg University Hospital, Heidelberg, Germany;6. Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany;1. Department of Surgery, University of Minnesota, Minneapolis, Minnesota;2. Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota;3. Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota |
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| Abstract: | BackgroundReducing the risk of death due to cardiovascular disease (CVD) is an important direction for diabetes prevention and treatment. The Chinese population with type 2 diabetes (T2D) has a high risk of developing CVD at relatively low body mass index (BMI) levels. Currently, no studies have evaluated the effect of bariatric surgery versus medical therapy on long-term CVD risk in patients with T2D and low BMI.ObjectivesTo compare bariatric surgery versus medical therapy for long-term CVD risk in Chinese patients with T2D and low BMI by using the China Prediction for ASCVD Risk equations and the United Kingdom Prospective Diabetes Study risk engine.SettingUniversity hospital, China.MethodsMedical records of patients with T2D with a BMI <35 kg/m2 undergoing bariatric surgery or medical therapy from May 2010 to December 2018 were reviewed. A 1:1 propensity score matching was performed by using 7 preoperative characteristics. Variables for calculating CVD risk scores over the 5-year follow-up were assessed.ResultsA total of 684 patients with T2D underwent bariatric surgery (n = 75) or medical therapy (n = 609), and 52 pairs of matched subjects were selected from both groups after propensity score matching. The 10-year and lifetime atherosclerotic CVD risk by using the China Prediction for ASCVD Risk equation at 5 years follow-up period in the bariatric surgery group improved significantly compared with the medical therapy group. In the fifth year of follow-up, the 10-year risk of coronary heart disease, fatal coronary heart disease, stroke, and fatal stroke by using the United Kingdom Prospective Diabetes Study risk engine were much lower in the bariatric surgery group than in the medical therapy group (10.37 ± 5.64% versus 27.25 ± 7.28%, P = .004; 6.3 ± 4.5% versus 22.3 ± 7.35%, P = .002; 4.97 ± 3.73% versus 15.05 ± 3.63%, P = .001; .59 ± .45% versus 1.52 ± .14%, P < .001. respectively). The use of glucose-lowering medications, including insulin, was reduced from baseline in both groups, and patients in the bariatric surgery group required significantly fewer of these medications than those in the medical therapy group.ConclusionBariatric surgery in patients with T2D and low BMI conferred a lower calculated risk of CVD compared with medical therapy over 5 years of follow-up. |
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| Keywords: | Type 2 diabetes Bariatric surgery Medical therapy Cardiovascular disease China-PAR equation UKPDS risk score |
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