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- Eliasson, Björn, 1959, et al.
(author)
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Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: A nationwide, matched, observational cohort study
- 2015
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In: Lancet Diabetes and Endocrinology. - : Elsevier. - 2213-8587 .- 2213-8595. ; 3:11, s. 847-854
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Journal article (peer-reviewed)abstract
- Background: In patients with diabetes and obesity specifically, no studies have examined mortality after bariatric surgery. We did a nationwide study in Sweden to examine risks of cardiovascular disease and mortality in patients with obesity and diabetes who had undergone bariatric surgery (Roux-en-Y gastric bypass [RYGB]). Methods: In this nationwide, matched, observational cohort study, we merged data for patients who had undergone RYGB registered in the Scandinavian Obesity Surgery Registry with other national databases, and identified matched controls (on the basis of sex, age, BMI, and calendar time [year]) who had not undergone bariatric surgery from the National Diabetes Registry. We assessed risks of cardiovascular disease and death using a Cox proportional-hazards regression model and other methods to examine the treatment effect while accounting for residual confounding. Primary outcomes were total mortality, cardiovascular death, and fatal or non-fatal myocardial infarction. Findings: Between Jan 1, 2007, and Dec 31, 2014, we obtained data for 6132 patients who had undergone RYGB and 6132 control patients who had not. Median follow-up was 3·5 years (IQR 2·1-4·7). We noted a 58% relative risk reduction (hazard ratio [HR] 0·42, 95% CI 0·30-0·57; p<0·0001) in overall mortality in the RYGB group compared with the controls. The risk of fatal or non-fatal myocardial infarction was 49% lower (HR 0·51, 0·29-0·91; p=0·021) and that of cardiovascular death was 59% lower (0·41, 0·19-0·90; p=0·026) in the RYGB group than in the control group. 5 year absolute risks of death were 1·8% (95% CI 1·5-2·2) in the RYGB group and 5·8% (5·0-6·8) in the control group. Interpretation: Our findings provide support for the benefits of RYGB surgery for patients with obesity and type 2 diabetes. The causes of these beneficial effects may be the weight reduction per se, changes in physiology and metabolism, improved care and treatment, improvements in lifestyle and risk factors, or combinations of these factors. Funding: Swedish Association of Local Authorities and Regions and Region Västra Götaland. © 2015 Elsevier Ltd.
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| 2. |
- Liakopoulos, Vasileios, et al.
(author)
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Changes in risk factors and their contribution to reduction of mortality risk following gastric bypass surgery among obese individuals with type 2 diabetes: A nationwide, matched, observational cohort study
- 2017
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In: BMJ Open Diabetes Research and Care. - : BMJ. - 2052-4897. ; 5:1
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Journal article (peer-reviewed)abstract
- Objective We recently showed that Roux-en-Y gastric bypass (RYGB) reduces risks of mortality, cardiovascular death and myocardial infarction in obese individuals compared with matched patients with diabetes mellitus (DM). We have examined changes in risk factors after RYGB, with the aim of explaining these effects. Research design and methods We matched (1:1) 6132 RYGB patients with DM reported to the Scandinavian Obesity Surgery Register with patients who had not undergone RYGB, based on sex, age, body mass index (BMI) and time, and assessed effects 2007-2014. We used causal mediation analysis to study effects mediated through changes to BMI and risk factors at 1 year based on Cox proportional hazards models. Results Baseline BMI was 42 kg/m2. Following RYGB, the lowest BMI was observed after 2 years (mean 31.9 kg/m2), and hemoglobin A1c (HbA1c) after 1 year (mean 6.32% (45.6 mmol/mol)). Maximum high-density lipoprotein (HDL) cholesterol was observed after 3-5 years (mean 1.46 mmol/L). Differences in BMI, HbA1c and HDL between the groups were statistically significant up to 6 years, and 2-3 years for low-density lipoprotein (LDL) and blood pressure, despite fewer glucose-lowering, hypertensive and lipid-lowering treatments. The causal mediation analysis suggested that RYGB has a positive effect on mortality risk, mainly by means of weight reduction (as opposed to changes to the risk factors analyzed). Conclusions Improvements in risk factors might contribute to the reduction of mortality risk after RYGB in obese individuals with type 2 diabetes, but the main effect seems to be mediated through a decrease in BMI, which could serve as a proxy for several mechanisms. © 2017, BMJ Publishing Group. All rights reserved.
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| 3. |
- Liakopoulos, Vasileios
(author)
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Effects of gastric bypass surgery in patients with obesity and type 2 diabetes
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background: The effects of Roux-en-Y gastric bypass (GBP) have not been adequately explored in patients with concurrent obesity and type 2 diabetes mellitus (T2DM) to the same extent as has occurred for individuals with obesity alone. The overall aim of this thesis is to thoroughly examine the effects of GBP surgery in patients with obesity and T2DM in terms of cardiovascular disease and mortality, changes in various comorbidities, risk factors, and renal function as well as reporting adverse events. Method: The reported studies are based mainly on merging data from two nationwide quality registries in Sweden (the National Diabetes Register and Scandinavian Obesity Surgery Register) as well as other national databases. Our study population of individuals with T2DM who had undergone GBP was matched with respect to baseline parameters such as sex, age, body mass index (BMI), and calendar year with controls who did not undergo surgery. The risks of postoperative outcomes were assessed using Cox regression models adjusted for various factors depending on endpoints. Results: Assessing data for 6,132 patients in each group from 2007 to 2014, we found a 58% relative risk reduction in overall mortality, a 59% lower risk of cardiovascular death, and a 49% lower risk of fatal or non-fatal myocardial infarction in the GBP group compared to controls. Following GBP, there were beneficial changes in BMI, hemoglobin A1c, blood lipids, and blood pressure compared to controls despite less frequent use of antidiabetic, antihypertensive, and antihyperlipidemic medications. The improvements in risk factors might contribute to the reduction of mortality risk after GBP in individuals with obesity and T2DM, but the main effect seems to be mediated through the decrease in BMI. New analyses of data for 5,321 individuals during 2007 to 2015 confirmed lower incidences of all-cause mortality and cardiovascular disease, demonstrated beneficial effects on severe kidney disease, and showed increased risks (2-fold to 9-fold) for several short-term postsurgical complications compared to controls. There were long-term adverse consequences of GBP compared to controls: there was a 92% higher risk of anemia, a 3-fold increase in nutritional deficiencies, a 33% higher risk for psychiatric diagnoses, and a 3-fold increase in alcohol abuse. The risk rates for most outcomes relating to renal function were lower after GBP. Risks of a composite of severe renal disease or halved estimated glomerular filtration rate (eGFR), and cardiovascular and renal mortality, were generally lower after GBP in all eGFR strata, even in patients with the lowest eGFR. Conclusion: The benefits of GBP for patients with obesity and T2DM on mortality, cardiovascular risk, and a broad spectrum of clinical diagnoses might be associated to changes in several risk factors; however, the main effect seems to be mediated through weight reduction. Interestingly, the positive effects of GBP are found for almost all categories of renal function, at the same time delaying deterioration to end-stage renal disease. However, the panorama of both short- and long-term adverse events suggests a more effective selection of patients who genuinely are eligible for such an intervention.
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| 4. |
- Liakopoulos, Vasileios, et al.
(author)
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Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: Nationwide, matched, observational cohort study
- 2019
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In: BMJ Open. - : BMJ. - 2044-6055. ; 9:1
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Journal article (peer-reviewed)abstract
- © Author(s) (or their employer(s)) 2019. Objectives: Long-term effects of gastric bypass (GBP) surgery have been presented in observational and randomised studies, but there are only limited data for persons with obesity and type 2 diabetes mellitus (T2DM) regarding postoperative complications. Design: This is a nationwide observational study based on two quality registers in Sweden (National Diabetes Register, NDR and Scandinavian Obesity Surgery Register, SOReg) and other national databases. Setting: After merging the data, we matched individuals with T2DM who had undergone GBP with those not surgically treated for obesity on propensity score, based on sex, age, body mass index (BMI) and calendar time. The risks of postoperative outcomes (rehospitalisations) were assessed using Cox regression models. Participants: We identified 5321 patients with T2DM in the SOReg and 5321 matched controls in the NDR, aged 18-65 years, with BMI >27.5 kg/m 2 ; and followed for up to 9 years. Primary and secondary outcome measures: We assessed risks for all-cause mortality and hospitalisations for cardiovascular disease, severe kidney disease, along with surgical and other medical conditions. Results: The results agree with the previously suggested lower risks of all-cause mortality (49%) and cardiovascular disease (34%), and we also found positive effects for severe kidney disease but significantly increased risks (twofold to ninefold) of several short-term complications after GBP, such as abdominal pain and gastrointestinal conditions, frequently requiring surgical procedures, apart from reconstructive plastic surgery. Long-term, the risk of anaemia was 92% higher, malnutrition developed approximately three times as often, psychiatric diagnoses were 33% more frequent and alcohol abuse was three times as great as in the control group. Conclusions: This nationwide study confirms the benefits and describes the panorama of adverse events after bariatric surgery in persons with obesity and T2DM. Long-term postoperative monitoring and support, as better selection of patients by appropriate specialists in interdisciplinary settings, should be provided to optimise the outcomes.
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| 5. |
- Liakopoulos, Vasileios, et al.
(author)
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Renal and Cardiovascular Outcomes After Weight Loss From Gastric Bypass Surgery in Type 2 Diabetes: Cardiorenal Risk Reductions Exceed Atherosclerotic Benefits
- 2020
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In: Diabetes care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 43:6, s. 1276-1284
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Journal article (peer-reviewed)abstract
- OBJECTIVE We examined detailed renal and cardiovascular (CV) outcomes after gastric bypass (GBP) surgery in people with obesity and type 2 diabetes mellitus (T2DM), across several renal function categories, in a nationwide cohort study. RESEARCH DESIGN AND METHODS We linked data from the National Diabetes Register and the Scandinavian Obesity Surgery Register with four national databases holding information on socioeconomic variables, medications, hospitalizations, and causes of death and matched 5,321 individuals with T2DM who had undergone GBP with 5,321 who had not (age 18-65 years, mean BMI >40 kg/m(2), mean follow-up >4.5 years). The risks of postoperative outcomes were assessed with Cox regression models. RESULTS During the first years postsurgery, there were small reductions in creatinine and albuminuria and stable estimated glomerular filtration rate (eGFR) in the GBP group. The incidence rates of most outcomes relating to renal function, CV disease, and mortality were lower after GBP, being particularly marked for heart failure (hazard ratio [HR] 0.33 [95% CI 0.24, 0.46]) and CV mortality (HR 0.36 [(95% CI 0.22, 0.58]). The risk of a composite of severe renal disease or halved eGFR was 0.56 (95% CI 0.44, 0.71), whereas nonfatal CV risk was lowered less (HR 0.82 [95% CI 0.70, 0.97]) after GBP. Risks for key outcomes were generally lower after GBP in all eGFR strata, including in individuals with eGFR CONCLUSIONS Our data suggest robust benefits for renal outcomes, heart failure, and CV mortality after GBP in individuals with obesity and T2DM. These results suggest that marked weight loss yields important benefits, particularly on the cardiorenal axis (including slowing progression to end-stage renal disease), whatever the baseline renal function status.
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