期刊
SURGERY FOR OBESITY AND RELATED DISEASES
卷 17, 期 1, 页码 23-35出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.soard.2020.09.002
关键词
Type 2 diabetes; Cardiovascular disease; Prediction; Severe obesity; Metabolic bariatric surgery; Medical therapy
类别
资金
- NCATS NIH HHS [UL1 TR002548, UL1 TR002345] Funding Source: Medline
- NCRR NIH HHS [UL1 RR025758, UL1 RR024134, UL1 RR024992, M01 RR000084, M01 RR000069, UL1 RR024989, UL1 RR025780, M01 RR000043, M01 RR000036, M01 RR001066, UL1 RR024139, UL1 RR024153, M01 RR000125, M01 RR014467] Funding Source: Medline
- NHLBI NIH HHS [K24 HL145076] Funding Source: Medline
- NIDDK NIH HHS [UM1 DK072493, U01 DK061242, P30 DK048520, K23 DK116720, U01 DK061239, U01 DK061254, U01 DK061212, U01 DK061230] Funding Source: Medline
A comparison of 30-year cardiovascular disease event risks in adolescents with type 2 diabetes and severe obesity undergoing different treatments revealed that metabolic bariatric surgery (MBS) can reduce the risk of cardiovascular events, while medical therapy may increase the risk among this population.
Background: Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. Objective: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. Setting: Longitudinal multicenter studies at University hospitals. Methods: A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n = 30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n = 63) studies was performed. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. Results: Participants with T2D from Teen-LABS (n = 30; mean 6 SD age = 16.9 +/- 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 +/- 9.5 kg/m(2)) and TODAY (n 5 63; 15.3 +/- 1.3 yr; 56% female; 71% white; BMI 40.5 +/- 4.9 kg/m(2)) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). Conclusion: Despite higher pretreatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase in risk among adolescents with T2D and severe obesity. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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