Bariatric Surgery and Long-term Cardiovascular Events

Sjöström, Lars; Peltonen, Markku; Jacobson, Peter; Sjöström, C. David; Karason, Kristjan; Wedel, Hans; Ahlin, Sofie; Anveden, Åsa; Bengtsson, Calle; Bergmark, Gerd; Bouchard, Claude; Carlsson, Björn; Dahlgren, S; Karlsson, Jan; Lindroos, Anna‐Karin; Lönroth, Hans; Narbro, Kristina; Näslund, Ingmar; Olbers, Torsten; Svensson, Per‐Arne; Carlsson, Lena

doi:10.1001/jama.2011.1914

Cited by 1,412 publications

(811 citation statements)

References 38 publications

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“…In morbidly obese people, bariatric surgery is associated with sustained weight loss and a substantial reduction in the two-year and ten-year incidence of diabetes. 32,33 Discussion By screening and risk-stratifying individuals as prediabetic, we may be able to develop a strategy to prevent prediabetes The identification and treatment of prediabetic individuals is therefore crucial to our efforts to make health care more affordable, prevent preventable disease, and save lives. Recent evidence presented in this article suggests that prevention of progression of prediabetes to diabetes and conversion of prediabetes to a normal glucose state is possible.…”

Section: Pharmacologic and Surgical Interventionmentioning

confidence: 99%

Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease

Tuso

2014

TPJ

178

136

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Section: Pharmacologic and Surgical Interventionmentioning

confidence: 99%

Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease

Tuso

2014

TPJ

178

136

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“…For instance, in the STENO-2 trial, which compared the effect of a targeted, intensified, multifactorial intervention with that of conventional treatment on modifiable risk factors for cardiovascular disease in T2DM patients with microalbuminuria, the mean follow-up was 7.8 years when an significant effect on a composite cardiovascular endpoint (death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, revascularization, and amputation) was reported [51]. In the Swedish Obese Subjects (SOS) study, compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of non fatal cardiovascular events in obese adults (with and without diabetes) after a median follow-up of 14.7 years [52]. The results of longer-term trials with DPP-4 inhibitors are waited with interest such as those of TECOS (follow up > 4 years but perhaps also too short ?)…”

Section: ) Reasons Related To Study Protocol A) Short Duration Of Fomentioning

confidence: 99%

Effects of glucose-lowering agents on vascular outcomes in type 2 diabetes: A critical reappraisal

Scheen

Charbonnel

2014

Diabetes & Metabolism

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Type 2 diabetes mellitus is strongly associated with cardiovascular complications, especially coronary artery disease. Numerous epidemiological studies showed a close relationship between major cardiovascular events and glycaemia and several pathophysiological mechanisms have been described that explain how hyperglycaemia induces vascular damages. However, randomized controlled trials that investigated either an intensive glucose lowering strategy versus standard care or the addition of a new glucose-lowering agent versus a placebo largely failed to demonstrate any clinical benefits in terms of cardiovascular morbidity or mortality. This lack of evidence led some people to contest the clinical efficacy of lowering blood glucose in patients with type 2 diabetes, despite its positive effects on microvascular complications. In this article, we analyze the various reasons that may explain such discrepancies. There are still strong arguments in favour of targeting hyperglycaemia, but avoiding other counterproductive effects, such as hypoglycaemia and weight gain, and integrating the glucose-lowering approach within a global multirisk strategy to reduce the burden of cardiovascular disease in type 2 diabetes.

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“…Current guidelines for bariatric surgery are based on BMI alone or on BMI in combination with comorbidities [11,12]. In the Swedish Obese Subjects (SOS) study (ClinicalTrials.gov registration NCT01479452), however, we have repeatedly found that baseline BMI is not a predictor of long-term bariatric surgery outcomes such as reduction of cardiovascular events, overall mortality and cancer or type 2 diabetes prevention and remission [3,9,[13][14][15]. In this study, we analyse the SOS study data in more detail to reveal whether incidence and remission rates for type 2 diabetes differ among participants with different baseline BMI but similar weight loss over 2 years.…”

Section: Introductionmentioning

confidence: 99%

Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese Subjects (SOS) study

et al. 2015

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Aims/hypothesis The aim of this work was to analyse the rates of incidence and remission of type 2 diabetes in relation to baseline BMI and weight change in the prospective, controlled Swedish Obese Subjects (SOS) study. Methods Three-thousand four-hundred and eighty-five obese individuals receiving bariatric surgery or conventional treatment were grouped into four baseline BMI categories (<35, 35-40, 40-45 or ≥45 kg/m 2 ) and five weight-change categories according to their BMI at 2 years (increase [≥1 BMI unit increase], no change [less than 1 BMI unit change], minor reduction [−1 to −9 BMI units], medium reduction [−10 to −14 BMI units] and major reduction [< −15 BMI units]). The incidence and remission of diabetes at 2 years was assessed. Results Among individuals with no weight change, diabetes incidence rates were 5.5%, 7.4%, 8.3% and 5.2%, in the four baseline BMI categories, respectively. In those with an initial BMI of 35-40, 40-45 and ≥45 kg/m 2 who attained a minor reduction in weight, the corresponding rates were 1.3%, 1.2% and 3.4%, respectively. In both the medium-and majorweight-reduction groups, diabetes incidence was ≤0.5%. Among individuals with diabetes at baseline, the remission rates were 15.3-26.9% in the no-weight-change groups, and 48.1-70% for individuals who attained a minor weight reduction. In the medium-and major-weight-reduction groups, the remission rate was 77-97%. There were no differences in 2 year incidence and remission rates between different baseline BMI groups that achieved the same degree of weight reduction. Conclusions/interpretation In obese individuals, the favourable effect of weight reduction on type 2 diabetes incidence and remission is independent of initial BMI. Trial registration ClinicalTrials.gov number NCT01479452

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Bariatric Surgery and Long-term Cardiovascular Events

Abstract: Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.

Cited by 1,412 publications

References 38 publications

Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease

Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease

Effects of glucose-lowering agents on vascular outcomes in type 2 diabetes: A critical reappraisal

Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese Subjects (SOS) study

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