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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-03052-0

摘要内容如下：

减肥代谢手术（BMS）和胰高血糖素样肽-1受体激动剂（GLP1-RA）对心血管结局影响的比较证据有限。在一项观察性、回顾性队列研究中，我们比较了接受BMS和GLP-1ra治疗的无CHF（原发性CHF）病史的肥胖和糖尿病患者充血性心力衰竭（CHF）的发病率。人群队列由Clalit Health Services的成员组成，既往无缺血性心脏病、缺血性卒中或充血性心力衰竭病史。在2008-2021年期间，根据临床特征，首次接受BMS治疗的患者与开始接受GLP-1RA治疗的患者以1:1的比例配对。该研究纳入了2205对配对患者（64.5%为女性），随访时间中位数为6.6年，最长为12年。26例（1.2%）BMS患者和90例（4.1%）GLP1-RA患者主要发生CHF，校正HR:0.43，95%CI:0.27-0.68。进一步调整体重减轻并未显著降低这种相关性，调整体重减轻后的HR:0.48，95%CI 0.28-0.82，表明差异效应不是通过BMS在最大体重减轻方面的相对优势介导的。在这项研究中，与GLP1-RA治疗相比，BMS与CHF主要发病率的更强降低相关。随着高效的下一代GLP1-RAS的使用越来越多，需要进行进一步的长期比较研究。

英文原文如下：

Abstracts

Comparative evidence for the effects of bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP1-RA) on cardiovascular outcomes is limited. Here, in an observational, retrospective cohort study, we compared the incidence of Congestive Heart Failure (CHF) in adults living with obesity and diabetes without history of CHF (primary CHF) treated with BMS versus GLP-1RA. The population cohort comprised members of Clalit Health Services with no prior history of ischemic heart disease, ischemic stroke, or CHF. During the time period of 2008 - 2021, patients who underwent their first BMS were matched 1:1 with patients who initiated treatment with GLP-1RA, based on clinical characteristics. The study included 2,205 matched pairs of patients (64.5% female), followed for a median of 6.6 years and up to 12 years. Primary incidence of CHF occurred in 26 (1.2%) BMS patients and in 90 GLP1-RA patients (4.1%), adjusted HR: 0.43, 95% CI: 0.27-0.68. Further adjustment for weight reduction did not significantly diminish this association, HR adjusted for weight reduction: 0.48, 95% CI 0.28-0.82, indicating that the differential effect was not mediated through the relative advantage of BMS in maximal weight reduction. In this study, BMS was associated with a stronger reduction in primary incidence of CHF compared to treatment with GLP1-RA. With the increasing use of highly potent next-generation GLP1-RAs, further comparative long-term studies are warranted.

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