Bariatric surgery and specialized medical treatment for severe obesity. Impact on cardiovascular risk factors and postsurgical pharmacokinetics of atorvastatin
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AbstractTreatment seeking patients with severe obesity might choose between specialized medical treatment and surgical treatment. Knowledge of what distinguishes patients that choose either treatment is sparse, with greater understanding also needed on what consequences this choice has for the prevalence, remission and new onset of comorbidities, as well as for the bioavailability of drugs. This has prompted the studies in Gunn Signe Jakobsen and her coauthors work on treatment seeking patients with severe obesity focusing on the prevalence of comorbidities, changes in the use of drugs for hypertension, diabetes and dyslipidaemia, as well as changes in bioavailability of atorvastatin. The methods used in the studies in the thesis; "Bariatric surgery and specialized medical treatment for severe obesity Impact on cardiovascular risk factors and postsurgical pharmacokinetics of atorvastatin "; are a cross-sectional study, a registry based cohort study and a prospective pharmacokinetic study. The results of the studies presented were: - The type and number of comorbidities associated with morbid obesity did not necessarily impact upon choice of treatment, but there was an increased odds for choosing surgery for patients with higher BMI, younger age and earlier onset of obesity. - Patients opting for bariatric surgery as opposed to specialized medical treatment had higher odds of experiencing remission, and significantly lower odds for new-onset of drug treated hypertension, diabetes and dyslipidaemia. Bariatric surgery seemed to not only induce remission but was also effective in preventing disease. - The bioavailability of atorvastatin was increased after bariatric surgery, with a normalization in the long term. This knowledge can give a better understanding of the population of patients seeking treatment for severe obesity and should be included in the shared decision process when helping the patient identify their preferences for treatment of severe obesity in the context of their values.
List of papers
|Paper I: Jakobsen GS, Hofsø D, Røislien J, Sandbu R, Hjelmesæth J. Morbidly obese patients--who undergoes bariatric surgery? Obesity surgery. 2010; 20(8):1142-8. The paper is included in the thesis. Also available at: https://doi.org/10.1007/s11695-009-0053-y|
|Paper II: Jakobsen GS, Småstuen MC, Sandbu S, Nordstrand N, Hofsø D, Hertel JK, Hjelmesæth J. Association of surgical vs. medical obesity treatment with long-term remission and new-onset of hypertension, diabetes and dyslipidemia. The paper is not available in DUO due to publisher restrictions. Journal of the American Medical Association (JAMA) 2018, vol 319(3), 291-301. The published version is available at: https://doi.org/10.1001/jama.2017.21055|
|Paper III: Jakobsen GS, Skottheim IB, Sandbu R, Christensen H, Roislien J, Asberg A, Hjelmesæth J. Long-term effects of gastric bypass and duodenal switch on systemic exposure of atorvastatin. Surgical endoscopy. 2013; 27(6):2094-101. The paper is included in the thesis. Also available at: https://doi.org/10.1007/s00464-012-2716-3|