Heart：减肥手术或降低患者心脏疾病和中风风险

近日，刊登在国际杂志Heart上的一篇研究报告指出，减肥手术，即限制性胃束带手术和其它类型的胃旁路术可以完全降低心脏疾病和中风的发病风险。每年由于肥胖和过重会导致260万人丧生，证据也显示，过度的机体脂肪会产生有害的化学骨质及不正常的胃肠激素，这样就容易产生机体炎症以及胰岛素耐药性。

研究者从数据库中对73项相关研究，涉及20，000人的研究数据进行了分析，其中患者平均年龄为42岁，四分之三的人为女性。数据揭示了在减肥手术后，患者的高血压、肥胖症、以及高血脂的流行度降低为44%、24%以及44%。减肥手术后，如中风、心衰等发病风险也明显降低。

随后作者又对18项研究，涉及713人，这些患者符合胃旁路术手术对心衰以及心脏结构改变的影响相关的标准，对这些数据的分析揭示了，手术操作步骤可以明显改善患者的左心室质量、心脏泵出血液的比例以及等容舒张时间或心脏收缩舒缓时间。

研究者表示，减肥手术可以有效地抑制心血管事件发生的比例，而且影响心血管风险因素的大小令人印象深刻，研究者肯定，减肥手术也并不是没有其风险所在，但是其不仅既可以降低心脏疾病和中风的发病风险，而且可以改善心脏自身的健康。

与心脏相关的拓展阅读：

• JACC：第三军医大学新桥医院报道心脏副神经节瘤一例
• PLoS ONE：胆固醇诱发老年性痴呆症和心脏病的作用机制
• EP：伴左室收缩功能减低的无器质性心脏病室性早搏患者的心电图及心电生理特征
• AJHG：有益脂肪或许能靶向miRNA降低心脏病风险
• Circulation：健康饮食或可代替药物降低个体心脏病发作的风险
• Nature：研究人员利用小分子RNA诱导心脏组织再生
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Bariatric surgery and cardiovascular outcomes: a systematic review

Purpose To quantify the impact of bariatric surgery on cardiovascular (CV) risk factors, and on cardiac structure and function. Data sources Three major databases (PubMed, Medline and Cochrane) were searched for original studies written in English. Study selection Original articles reporting CV risk factors or non-invasive imaging parameters for patients undergoing bariatric surgery, from January 1950 to June 2012. Data extraction Data extraction from selected studies was based on protocol-defined criteria that included study design, methods, patient characteristics, surgical procedures, weight loss, changes in CV risk factors, cardiac structure and cardiac function postoperatively. Data synthesis 73 CV risk factor studies involving 19 543 subjects were included (mean age 42 years, 76% female). Baseline prevalence of hypertension, diabetes and hyperlipidaemia were 44%, 24%, and 44%, respectively. Mean follow-up was 57.8 months (range 3–176) and average excess weight loss was 54% (range 16–87%). Postoperative resolution/improvement of hypertension occurred in 63% of subjects, of diabetes in 73% and of hyperlipidaemia in 65%. Echocardiographic data from 713 subjects demonstrated statistically significant improvements in left ventricular mass, E/A ratio, and isovolumic relaxation time postoperatively. Limitations Diagnostic criteria, CV risk factor reporting, and imaging parameters were not uniform across all studies. Study groups were heterogeneous in their demographics, operative technique and follow-up period. Conclusions This systematic review highlights the benefits of bariatric surgery in reducing risk factors for CV disease. There is also evidence for left ventricular hypertrophy regression and improved diastolic function. These observations provide further evidence that bariatric surgery enhances future CV health for obese individuals.