Association of cholecystectomy with changes in metabolic health and cardiovascular disease: a retrospective cohort study

Association of cholecystectomy with changes in metabolic health and cardiovascular disease: a retrospective cohort study

Our large, retrospective population-based cohort study shows that cholecystectomy is associated with a higher risk of cardiovascular disease, particularly within two years of surgery.This increased risk was more pronounced in men with a BMI < 25 kg/m2, and patients with more medical comorbidities and a Charlson Comorbidity Index of 2 or higher. This increased CVD risk was no longer observed when patients were followed for more than 2 years postoperatively. Of note, cholecystectomy was associated with changes in systolic blood pressure, total cholesterol, and body mass index after surgery.

A previous study showed that total bile acids (TBA) are biomarkers of liver injury. Therefore, it is recommended to monitor IBA to observe liver damage in different breeds.33. In Figure 2, when cholecystectomy is performed, the first mechanism is to improve intermediary metabolic conditions through inhibition of fat absorption or weight loss, thereby reducing the risk of cardiovascular disease.Another mechanism known to have microbiome problems3,34. It is unclear whether this mechanism reduces risk after bile is lost, but there may be primary biliary cirrhosis or mechanisms leading to liver damage or abdominal inflammation, but other mechanisms have not been identified. It can be suggested that the mechanism of this study suggests that the risk of CVD after cholecystectomy is not related to weight loss or improvement in intermediate metabolic status.

figure 2
figure 2

Mechanisms of cholecystectomy and metabolism.

Previous studies have shown that the cholecystectomy group has a higher risk of diabetes, hypertension, and dyslipidemia than the non-surgical group32,35.The proportion of non-smokers in the control group was higher than that in the surgery group32. This condition suggests that people who undergo cholecystectomy are those at higher risk for CVD.

From this perspective, previous studies include research on the relationship between cholecystectomy and digestive organ cancers such as colon cancer, and research on the relationship between cholecystectomy and Parkinson’s disease and other degenerative brain diseases. Based on this background, this study was designed to investigate whether cholecystectomy affects cardiovascular disease. In order to overcome the limitations of the current conclusions of many papers that have not yet found an intermediate explanatory stage between cholecystectomy and the disease in which the variables are produced, we analyzed how cholecystectomy mainly affects the healthy metabolic indicators of our body in the short term and analyzed its Influence.

When selecting cholecystectomy subjects, in addition to having a history of hepatobiliary-related cancer and cardiovascular disease, subjects who underwent cholecystectomy were selected in a relatively healthy state. However, cholecystectomy subjects are inherently tall and have a body mass index that is basically susceptible to Influence. Cardiovascular diseases. As a result, cholecystectomy subjects showed a high risk of developing CVD during the follow-up period from the immediate postoperative period to 2015, especially CVD and CHD in the short time period from the immediate postoperative period to 2 years. In addition, the changes in body metabolic indicators in a short period of time were also analyzed, and it was found that most metabolic indicators tended to improve.

The existing hypothesis is that bile metabolism is affected after cholecystectomy, which will lead to an increase in cholesterol in the body by affecting cholesterol metabolism, and relevant studies have been conducted. Compared with previous studies, the advantage of this study is first to look at before and after, while the limitation of existing single-site studies is that patients who undergo cholecystectomy are basically patients with poor metabolic indicators and higher cholesterol levels. In this study, basically, the preoperative metabolic parameters of subjects who underwent cholecystectomy were worse than those of subjects who did not undergo cholecystectomy. However, after undergoing cholecystectomy surgery, the cholesterol dropped. Previous studies have hypothesized that cholecystectomy with these mechanisms alone would cause abnormal bile metabolism and increase cholesterol levels, but in this study there were higher cholecystectomy subjects at baseline but lower post-operative cholesterol levels or various indicators. decline. Therefore, several papers have proposed two mechanisms related to cholesterol metabolism after cholecystectomy, but this study believes that the part related to the cholesterol drop hypothesis is more likely. This is the conclusion of this study. However, the results at one point in the previous study are likely to be relevant to those at metabolic risk, but this study has a great strength in that it considered a before-and-after comparison to see exactly the effects of cholecystectomy. Therefore, from the above findings, the overall beneficial effect of cholecystectomy is estimated based on cholesterol metabolism.

Additionally, patients who underwent cholecystectomy had a reduced risk of cardiovascular disease 2 years later, suggesting that the increased risk of cardiovascular disease associated with cholecystectomy may be ameliorated 2 years after cholecystectomy.Although there have been concerns in the past that cholecystectomy may have deleterious effects on metabolic markers such as cholesterol12the results of this study suggest more beneficial results.

Research limitations

A limitation of this study is that it is not a comprehensive examination of the database as it is a retrospective cohort study. Since the study was not conducted on a total population, the application of the findings to the entire population is limited due to the lack of population size. Secondly, in terms of operational definition, patients undergoing cholecystectomy may have underlying diseases such as gallbladder cancer, biliary tract cancer, liver cancer, etc., which are removed during liver transplantation, and therefore may be affected by each disease. In addition, the impact of cardiovascular disease and hepatobiliary-related underlying diseases may also reflect the above analysis results. Third, it is explained that it is a bridge between cholecystectomy and disease, but the above results cannot explain whether the primary result of cholecystectomy is changes in metabolic indicators or its causal relationship. Finally, in long-term analyses, the cholecystectomy patients in our study represent a healthy subpopulation with at least 2 years of survival, which may introduce type II error. However, to minimize survivorship bias, both cases and controls were given at least 2 years to survive. Therefore, it is important to note that it only implies an association and future research suggests that studies should be conducted to account for intermediate stages of cholecystectomy and outcome variables of the disease.

clinical competence

A cholecystectomy is a surgical procedure to remove an organ. There is a lot of concern because it can permanently affect the body. Some previous studies have shown an inverse association between cholecystectomy and cardiovascular disease, Parkinson’s disease, and gastrointestinal cancers. However, the above-mentioned research can alleviate people’s concerns about the results of previous studies. It could be explained that the short-term effects of cholecystectomy on cardiovascular disease are influenced by the patient’s preoperative health status. In patients two years after cholecystectomy, contrary to concerns raised by existing studies, metabolic health improved after surgery. After two years, the association between cholecystectomy and cardiovascular disease declined.

Translation Outlook

Patients who undergo cholecystectomy for relatively noncritical illness do not have an increased risk of cardiovascular disease in the long term because metabolic markers become healthier in the short term as a result of the surgery.

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