One Year Improvements in Cardiovascular Risk Factors: a Comparative Trial of Laparoscopic Roux-en-Y Gastric Bypass vs. Adjustable Gastric Banding
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Coronary artery disease (CAD) is the leading cause of death in the industrialized world with obesity as a leading preventable risk factor. Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) have been shown to improve certain biochemical cardiovascular risk factors (BCRFs) at 1 year post-op, however no study has directly compared the 12-month BCRF improvements of RYGB vs. LAGB.
At a single academic institution (2004–2009), we measured BCRF in 838 consecutive bariatric patients (765 RYGB, 73 LAGB) pre-operatively and at 12 months post-operatively. BCRF included total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (Trig), Trig/HDL ratio, lipoprotein(a) (Lp(a)), homocysteine (HmC), high sensitivity C-reactive protein (hs-CRP), fasting insulin (FI), and hemoglobin A1C (Hgb A1C). Pre-op and 12-month post-op values were compared by a paired t test of equal variance.
At 12 months post-op, RYGB patients had lost 77% of their excess weight and had significant improvements in TC, LDL, HDL, Trig, Trig/HDL, HmC, hs-CRP, FI, and Hgb A1C. LAGB patients lost 47.6% of their excess weight and had significant improvements in Trig, Trig/HDL, HmC, hs-CRP, and Hgb A1C. Having RYGB instead of LAGB was predictive of significantly greater improvements in TC at 12 months post-operatively.
In this study, both RYGB and LAGB demonstrated significant weight loss and improvements in BCRF at 12 months post-op. RYGB produced significant improvements in a greater number of BCRFs and in some instances the 12-month post-op BCRF values were significantly lower risk in RYGB vs. LAGB patients.
- Kung H, Hoyert D, Xu J, et al. Deaths: Final Data for 2005. National Vital Statistics Report Centers for Disease Control and Prevention 2008;56(10).
- Hubert, HB, Feinleib, M, McNamara, PM (1983) Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 67: pp. 968-977
- Lamon-Fava, S, Wilson, PW, Schaefer, EJ (1996) Impact of body mass index on coronary heart disease risk factors in men and women. The Framingham Offspring Study. Arterioscler Thromb Vasc Biol 16: pp. 1509-1515
- Lee, IM, Manson, JE, Hennekens, CH (1993) Body weight and mortality. A 27-year follow-up of middle-aged men. Jama 270: pp. 2823-2828 CrossRef
- Manson, JE, Willett, WC, Stampfer, MJ (1995) Body weight and mortality among women. N Engl J Med 333: pp. 677-685 CrossRef
- Bleich, S, Cutler, D, Murray, C (2008) Why is the developed world obese?. Annu Rev Public Health 29: pp. 273-295 CrossRef
- New CDC Study Finds No Increase in Obesity Among Adults; But Levels Still High. CDC National Center for Health Statistics 2007, November 28.
- Ridker, PM (1999) Evaluating novel cardiovascular risk factors: can we better predict heart attacks?. Ann Intern Med 130: pp. 933-937
- Braunwald, E (1997) Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 337: pp. 1360-1369 CrossRef
- Luc, G, Bard, JM, Ferrieres, J (2002) Value of HDL cholesterol, apolipoprotein A-I, lipoprotein A-I, and lipoprotein A-I/A-II in prediction of coronary heart disease: the PRIME Study. Prospective Epidemiological Study of Myocardial Infarction. Arterioscler Thromb Vasc Biol 22: pp. 1155-1161 CrossRef
- Nygard, O, Nordrehaug, JE, Refsum, H (1997) Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med 337: pp. 230-236 CrossRef
- Ridker, PM, Rifai, N, Rose, L (2002) Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 347: pp. 1557-1565 CrossRef
- McTigue, KM, Harris, R, Hemphill, B (2003) Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 139: pp. 933-949
- Christou, NV, Sampalis, JS, Liberman, M (2004) Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 240: pp. 416-423 CrossRef
- Brolin, RE, Kenler, HA, Wilson, AC (1990) Serum lipids after gastric bypass surgery for morbid obesity. Int J Obes 14: pp. 939-950
- Nguyen, NT, Varela, E, Sabio, A (2006) Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg 203: pp. 24-29 CrossRef
- Brolin, RE, Bradley, LJ, Wilson, AC (2000) Lipid risk profile and weight stability after gastric restrictive operations for morbid obesity. J Gastrointest Surg 4: pp. 464-469 CrossRef
- Gleysteen, JJ, Barboriak, JJ (1983) Improvement in heart disease risk factors after gastric bypass. Arch Surg 118: pp. 681-684
- Torquati, A, Wright, K, Melvin, W (2007) Effect of gastric bypass operation on Framingham and actual risk of cardiovascular events in class II to III obesity. J Am Coll Surg 204: pp. 776-782 CrossRef
- Arterburn D, Schauer DP, Wise RE, et al. Change in Predicted 10-Year Cardiovascular Risk Following Laparoscopic Roux-en-Y Gastric Bypass Surgery. Obes Surg 2008.
- Vogel, JA, Franklin, BA, Zalesin, KC (2007) Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery. Am J Cardiol 99: pp. 222-226 CrossRef
- Adams, TD, Gress, RE, Smith, SC (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357: pp. 753-761 CrossRef
- Shargorodsky, M, Fleed, A, Boaz, M (2006) The effect of a rapid weight loss induced by laparoscopic adjustable gastric banding on arterial stiffness, metabolic and inflammatory parameters in patients with morbid obesity. Int J Obes (Lond) 30: pp. 1632-1638 CrossRef
- Dixon, JB, O'Brien, PE (2002) Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obes Res 10: pp. 903-910 CrossRef
- Buchwald, H, Varco, RL, Matts, JP (1990) Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. Report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med 323: pp. 946-955 CrossRef
- Buchwald, H, Varco, RL, Boen, JR (1998) Effective lipid modification by partial ileal bypass reduced long-term coronary heart disease mortality and morbidity: five-year posttrial follow-up report from the POSCH. Program on the Surgical Control of the Hyperlipidemias. Arch Intern Med 158: pp. 1253-1261 CrossRef
- Williams, DB, Hagedorn, JC, Lawson, EH (2007) Gastric bypass reduces biochemical cardiac risk factors. Surg Obes Relat Dis 3: pp. 8-13 CrossRef
- Weber, M, Muller, MK, Bucher, T (2004) Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg 240: pp. 975-982 CrossRef
- Batsis, JA, Romero-Corral, A, Collazo-Clavell, ML (2007) Effect of weight loss on predicted cardiovascular risk: change in cardiac risk after bariatric surgery. Obesity (Silver Spring) 15: pp. 772-784 CrossRef
- Levy, P, Fried, M, Santini, F (2007) The comparative effects of bariatric surgery on weight and type 2 diabetes. Obes Surg 17: pp. 1248-1256 CrossRef
- One Year Improvements in Cardiovascular Risk Factors: a Comparative Trial of Laparoscopic Roux-en-Y Gastric Bypass vs. Adjustable Gastric Banding
Volume 20, Issue 5 , pp 578-582
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Cardiovascular risk factors
- Bariatric surgery
- Comparative trial
- Roux-en-Y gastric bypass
- Laparoscopic adjustable gastric banding
- C-reactive protein
- Fasting insulin
- Hemoglobin A1C
- Industry Sectors
- Author Affiliations
- 1. Department of General Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
- 2. 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA