title: Long-term mortality and incidence of cardiovascular diseases and type 2 diabetes in diabetic and nondiabetic obese patients undergoing gastric banding: a controlled study.
abstract: OBJECTIVE
  Aim of this retrospective study was to compare long-term mortality and incidence of new diseases [diabetes and cardiovascular (CV) disease] in morbidly obese diabetic and nondiabetic patients, undergoing gastric banding (LAGB) in comparison to medical treatment.
  
  
  METHODS
  Medical records of obese patients [body mass index (BMI) > 35 kg/m(2) undergoing LAGB (n = 385; 52 with diabetes) or medical treatment (controls, n = 681; 127 with diabetes), during the period 1995-2001 (visit 1)] were collected. Patients were matched for age, sex, BMI, and blood pressure. Identification codes of patients were entered in the Italian National Health System Lumbardy database, that contains life status, causes of death, as well as exemptions, drug prescriptions, and hospital admissions (proxies of diseases) from visit 1 to September 2012. Survival was compared across LAGB patients and matched controls using Kaplan-Meier plots adjusted Cox regression analyses.
  
  
  RESULTS
  Observation period was 13.9 ± 1.87 (mean ± SD). Mortality rate was 2.6, 6.6, and 10.1 % in controls at 5, 10, and 15 years, respectively; mortality rate was 0.8, 2.5, and 3.1 % in LAGB patients at 5, 10, and 15 years, respectively. Compared to controls, surgery was associated with reduced mortality [HR 0.35, 95 % CI 0.19-0.65, p < 0.001 at univariate analysis, HR 0.41, 95 % CI 0.21-0.76, p < 0.005 at adjusted analysis], similar in diabetic [HR 0.34, 95 % CI 0.13-0.87, p = 0.025] and nondiabetic [HR 0.42, 95 % CI 0.19-0.97, p = 0.041] patients. Surgery was also associated with lower incidence of diabetes (15 vs 48 cases, p = 0.035) and CV diseases (52 vs 124 cases, p = 0.048), and of hospital admissions (88 vs 197, p = 0.04).
  
  
  CONCLUSIONS
  Up to 17 years, gastric banding is associated with reduced mortality in diabetic and nondiabetic patients, and with reduced incidence of diabetes and cardiovascular diseases.
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. antonio.pontiroli@unimi.it.|Ospedale San Paolo, Milan, Italy. antonio.pontiroli@unimi.it.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Pontiroli
authors.affiliation: Ospedale San Paolo, Milan, Italy. zakariadrahmed@libero.it.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Zakaria
authors.affiliation: Ospedale San Paolo, Milan, Italy. ermanno.mantegazza@ao-sanpaolo.it.
authors.forename: Ermanno
authors.initials: E
authors.lastname: Mantegazza
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. alberto.morabito@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Morabito
authors.affiliation: Ospedale San Raffaele, Milan, Italy. saibene.alessandro@hsr.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Saibene
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. enrico.mozzi@unimi.it.|Ospedale Policlinico, Milan, Italy. enrico.mozzi@unimi.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Mozzi
authors.affiliation: Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. giancarlo.micheletto@unimi.it.|Istituto Clinico Sant Ambrogio, Milan, Italy. giancarlo.micheletto@unimi.it.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Micheletto
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000401:mortality*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors