| アブストラクト | BACKGROUND: The proinflammatory state and metabolic changes associated with obesity contribute to cerebrovascular disease. Bariatric surgery can achieve a reliable reduction in body weight and improved metabolic profile in obese patients. However, its impact on cerebrovascular morbidity remains unexplored. This study investigates the effect of bariatric surgery on long-term risk of major cerebrovascular events. METHODS: A retrospective cohort study was designed. Data was extracted from the Clinical Practice Research Datalink. 4212 bariatric surgery patients were compared to 4212 age, sex, and BMI-matched controls. The primary composite endpoint was occurrence of any major adverse cerebrovascular event. Secondary endpoints included composite endpoints of ischaemic events, haemorrhagic events, individual components of the primary endpoint alone and all-cause mortality. An adjusted Cox proportional hazards model was implemented to analyse time to event data. RESULTS: Mean follow-up length was 11.4 years. The primary endpoint occurred in 73 patients. The bariatric surgery group had significantly lower adjusted major cerebrovascular event rates (HR 0.352, 95 %CI 0.195-0.637). Bariatric surgery was associated with lower rates of ischaemic events (HR 0.315, 95 %CI 0.156-0.635), particularly from transient ischaemic attacks (HR 0.364, 95 %CI 0.171-0.775). There was no difference in the rate of haemorrhagic events (HR 0.442, 95 %CI 0.147-1.330) or acute ischaemic stroke (HR 0.221, 95 %CI 0.046-1.054). In total 229 patients died during follow-up. Overall, all-cause mortality was significantly lower in the bariatric surgery group (HR 0.352, 95 %CI 0.195-0.637). CONCLUSIONS: This study identifies an association between bariatric surgery and lower long-term risk of major adverse cerebrovascular events in patients with obesity. |
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| ジャーナル名 | Clinical neurology and neurosurgery |
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| 投稿日 | 2021/2/23 |
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| 投稿者 | Moussa, Osama; Ardissino, Maddalena; Tang, Alice; Edwards, Jonathan; Heaton, Tobias; Khan, Omar; Tsang, Kevin; Collins, Peter; Purkayastha, Sanjay |
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| 組織名 | Department of Surgery and Cancer, Imperial College, Praed Street, London, W2 1NY,;United Kingdom.;Department of Medicine, Imperial College London, Exhibition Road, London, SW7;2AZ, United Kingdom.;2AZ, United Kingdom. Electronic address: jwe116@ic.ac.uk.;Department of Upper GI and Bariatric Surgery, St George's University of London,;London, SW17 0RE, United Kingdom.;Department of Neurosurgery, Imperial College NHS Trust, Charing Cross Hospital,;London, W6 8RF, United Kingdom.;2AZ, United Kingdom; Royal Brompton Hospital and National Heart and Lung;Institute, Imperial College London, London, SW3 6NP, United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/33618173/ |
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