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High cardiovascular risk patients benefit more from bariatric surgery than low cardiovascular risk patients

  • 2018 SAGES Oral
  • Published:
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Abstract

Introduction

Atherosclerotic cardiovascular disease (ASCVD) and Framingham risk scores (FRS) are used to calculate 10-year risk of coronary death, nonfatal myocardial infarction, or fatal/nonfatal stroke. Our goal is to evaluate the association between preoperative cardiovascular risk and weight loss.

Methods

We retrospectively reviewed bariatric surgeries from 2010 to 2016. Patients who met criteria for calculating 10-year ASCVD score and FRS were included. Data collected included baseline demographics, perioperative parameters, and postoperative outcomes at 12 months. Simple linear regression and multiple linear regression models were applied to test influence of individual or multiple factors of interest on 12-month weight loss outcomes.

Results

Of 1330 bariatric patients studied, 360 patients met criteria for ASCVD and FRS calculation. Sleeve gastrectomy (LSG) was the most prevalent surgery 63.05%, followed by Roux-en-Y gastric bypass (LRYGB) 20.55%, revision procedures 11.9%, and adjustable gastric banding (LAGB) 4.4%. Initial BMI was 42.71 ± 7.85 kg/m2 for females and 42.72k ± 7.42 kg/m2 for males, with a 12-month percentage of estimated BMI loss (%EBMIL) of 66.51% in females and 60.29% in males. Preoperative 10-year ASCVD score was higher in males than females with a 34.73% relative risk reduction (RRR) in males and 35.3% RRR in females at 12-month follow-up. Regarding FRS, preoperative risk was 33.13 ± 21.1% in males and 15.71 ± 14.52% in females, with an RRR of 25.8% in males and 32.2% in females. Univariate analysis of preoperative FRS and %EBMIL showed that for every percentage unit increase in the patient’s preoperative FRS, %EBMIL decreases 0.31 percentile unit (P < 0.001). Furthermore, preoperative ASCVD score is also significantly associated with %EMBIL—for every percentage unit increase in preoperative ASCVD score, %EBMIL decreases 0.42 percentile credits.

Conclusion

Study results suggest ASCVD and FRS are equally reduced after bariatric surgery, especially after LSG and LRYGB. Moreover, preoperative FRS and ASCVD risk score showed an inversely proportional relationship with %EBMIL loss at 12 months.

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Authors and Affiliations

  1. Department of General Surgery and The Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    David Gutierrez Blanco, David Romero Funes, Giulio Giambartolomei, Emanuele Lo Menzo, Samuel Szomstein & Raul J. Rosenthal

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  1. David Gutierrez Blanco
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Correspondence to Raul J. Rosenthal.

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David Gutierrez Blanco, David Romero Funes, Giulio Giambartolomei, Emanuele Lo Menzo Samuel Szomstein, and Raul J. Rosenthal have no conflicts of interest or financial ties to disclose.

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Blanco, D.G., Funes, D.R., Giambartolomei, G. et al. High cardiovascular risk patients benefit more from bariatric surgery than low cardiovascular risk patients. Surg Endosc 33, 1626–1631 (2019). https://doi.org/10.1007/s00464-018-6437-0

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