Skip to main content

Advertisement

Log in

Improvement of the 10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Following Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Several studies have shown improvement in cardiometabolic risk factors, as well as in the related mortality following bariatric surgery. However, few studies have assessed changes in the estimated cardiovascular risk.

Objective

The aim of the present study was to investigate the effect of bariatric surgery on the estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk.

Patients and Methods

We performed a retrospective analysis from a prospectively maintained database of patients who underwent a primary bariatric procedure from 2004 to 2018. The 10-year ASCVD risk was estimated before and after 1 year of surgery using the ASCVD Risk Estimator Plus of the American College of Cardiology. Changes in the ASCVD risk were evaluated.

Results

There were 58 (51.3%) women and 55 (48.7%) men with a mean age of 49.9 years. Before surgery, 64 patients had arterial hypertension, 57 T2DM, and 49 were smokers. Baseline mean estimated 10-year ASCVD risk was 8.50 ± 7.92%. Fifty-one (45.1%), 10 (8.8%), 41 (36.3%), and 11 (9.7%) patients were classified as low, borderline, intermediate, and high risk, respectively. One year after surgery, 92.9% of the patients showed a reduction of the estimated 10-year ASCVD risk. Mean values were significantly lower (5.31 ± 5.95%) when compared to basal ones (p < 0.0001). According to the risk classification, 71 (62.8%), 13 (11.5%), 26 (23%), and 3 (2.7%) were cataloged as low, borderline, intermediate, and high risk, respectively.

Conclusions

Surgically induced weight loss leads to a significant improvement in the estimated 10-year ASCVD risk, 1 year after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ASCVD:

Atherosclerotic cardiovascular disease

BMI:

Body mass index

CAC:

Coronary artery calcium score

EWL:

Excess body weight loss

FRS:

Framingham risk score

HDL-C:

High-density lipoprotein cholesterol

IMT:

Carotid intima-media thickness

LDL-C:

Low-density lipoprotein cholesterol

MAPSE:

Mitral annular plane systolic excursion

RYGB:

Roux-en-Y gastric bypass

SG:

Sleeve gastrectomy

T2DM:

Type 2 diabetes mellitus

TAPSE:

Tricuspid annular plane systolic excursion

TWL:

Total weight loss

References

  1. Engin A. The definition and prevalence of obesity and metabolic syndrome. In: Adv Exp Med Biol; 2017. p. 1–17.

    Google Scholar 

  2. Ginter E, Simko V. Becoming overweight: is there a health risk? Bratisl Lek Listy. 2014;115:527–31. https://doi.org/10.4149/bll_2014_102.

    Article  CAS  PubMed  Google Scholar 

  3. Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083–96. https://doi.org/10.1016/S0140-6736(09)60318-4.

    Article  PubMed Central  Google Scholar 

  4. Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Circulation. 2006;113:898–918. https://doi.org/10.1161/CIRCULATIONAHA.106.171016.

    Article  PubMed  Google Scholar 

  5. Global Health Estimates. Deaths by cause, age, sex, by country and by region, 2000-2016, vol. 2018. Geneva: World Health Organization; 2016.

    Google Scholar 

  6. Shimada YJ, Tsugawa Y, Iso H, et al. Association between bariatric surgery and rate of hospitalisations for stable angina pectoris in obese adults. Heart. 2017;103:1009–14. https://doi.org/10.1136/heartjnl-2016-310757.

    Article  PubMed  Google Scholar 

  7. Ashrafian H, le Roux CW, Darzi A, et al. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118:2091–102. https://doi.org/10.1161/CIRCULATIONAHA.107.721027.

    Article  PubMed  Google Scholar 

  8. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61. https://doi.org/10.1056/NEJMoa066603.

    Article  CAS  PubMed  Google Scholar 

  9. Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56. https://doi.org/10.1001/jama.2011.1914.

    Article  PubMed  Google Scholar 

  10. Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA. 2019;322:1271. https://doi.org/10.1001/jama.2019.14231.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation. 2019;140:e596–646. https://doi.org/10.1161/CIR.0000000000000678.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25:587–606. https://doi.org/10.1007/s11695-015-1645-3.

    Article  PubMed  Google Scholar 

  13. Batsis JA, Sarr MG, Collazo-Clavell ML, et al. Cardiovascular risk after bariatric surgery for obesity. Am J Cardiol. 2008;102:930–7. https://doi.org/10.1016/j.amjcard.2008.05.040.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Torquati A, Wright K, Melvin W, et al. Effect of gastric bypass operation on Framingham and actual risk of cardiovascular events in class II to III obesity. J Am Coll Surg. 2007;204:776–82. https://doi.org/10.1016/j.jamcollsurg.2006.12.038.

    Article  PubMed  Google Scholar 

  15. 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. 2009;19:184–9. https://doi.org/10.1007/s11695-008-9534-7.

    Article  PubMed  Google Scholar 

  16. Vogel JA, Franklin BA, Zalesin KC, et al. Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery. Am J Cardiol. 2007;99:222–6. https://doi.org/10.1016/j.amjcard.2006.08.017.

    Article  PubMed  Google Scholar 

  17. Raygor V, Garcia L, Maron DJ, et al. The comparative effect of Roux-en-Y gastric bypass and sleeve gastrectomy on 10-year and lifetime Atherosclerotic cardiovascular disease risk. Obes Surg. 2019;29:3111–7. https://doi.org/10.1007/s11695-019-03948-8.

    Article  PubMed  Google Scholar 

  18. Tromba L, Tartaglia F, Carbotta S, et al. The role of sleeve gastrectomy in reducing cardiovascular risk. Obes Surg. 2017;27:1145–51. https://doi.org/10.1007/s11695-016-2441-4.

    Article  PubMed  Google Scholar 

  19. da Costa LD, Gadelha PS, Santa-Cruz F, et al. Cirurgia bariátrica e o escore de cálcio coronariano. Rev Col Bras Cir. 2019;46:e20192170. https://doi.org/10.1590/0100-6991e-20192170.

    Article  Google Scholar 

  20. Leeman M, van Mil SR, Al-Ghanam I, et al. Structural and functional vascular improvement 1 year after bariatric surgery: a prospective cohort study. Surg Obes Relat Dis. 2019;15:1773–9. https://doi.org/10.1016/j.soard.2019.08.012.

    Article  PubMed  Google Scholar 

  21. Taylor R, Valabhji J, Aveyard P, et al. Prevention and reversal of type 2 diabetes: highlights from a symposium at the 2019 Diabetes UK Annual Professional Conference. Diabet Med. 2019;36:359–65. https://doi.org/10.1111/dme.13892.

    Article  CAS  PubMed  Google Scholar 

  22. Leung M, Xie M, Durmush E, et al. Weight loss with sleeve gastrectomy in obese type 2 diabetes mellitus: impact on cardiac function. Obes Surg. 2016;26:321–6. https://doi.org/10.1007/s11695-015-1748-x.

    Article  PubMed  Google Scholar 

  23. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391:541–51. https://doi.org/10.1016/S0140-6736(17)33102-1.

    Article  PubMed  Google Scholar 

  24. Sjöström CD, Lissner L, Wedel H, et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS intervention study. Obes Res. 1999;7:477–84. https://doi.org/10.1002/j.1550-8528.1999.tb00436.x.

    Article  PubMed  Google Scholar 

  25. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81. https://doi.org/10.1016/S0140-6736(14)60460-8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mertens IL, van Gaal LF. Overweight, obesity, and blood pressure: the effects of modest weight reduction. Obes Res. 2000;8:270–8. https://doi.org/10.1038/oby.2000.32.

    Article  CAS  PubMed  Google Scholar 

  27. Fantin F, Giani A, Zoico E, et al. Weight loss and hypertension in obese subjects. Nutrients. 2019;11:1667. https://doi.org/10.3390/nu11071667.

    Article  CAS  PubMed Central  Google Scholar 

  28. Ruano M, Silvestre V, Castro R, et al. Morbid obesity, hypertensive disease and the renin-angiotensin-aldosterone axis. Obes Surg. 2005;15:670–6. https://doi.org/10.1381/0960892053923734.

    Article  CAS  PubMed  Google Scholar 

  29. Flores L, Vidal J, Núñez I, et al. Longitudinal changes of blood pressure after weight loss: factors involved. Surg Obes Relat Dis. 2015;11:215–21. https://doi.org/10.1016/j.soard.2014.04.028.

    Article  PubMed  Google Scholar 

  30. Suwannasrisuk P, Boonchaya-anant P, Houngngam N, et al. Changes in plasma aldosterone level after weight loss by bariatric surgery in morbidly obese patients. BMC Endocr Disord. 2020;20:45. https://doi.org/10.1186/s12902-020-0527-4.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Miguel F. Herrera.

Ethics declarations

Conflict of Interest Disclosure

The authors declare that they have no conflict of interest.

Ethical Statement

The institutional review board approved this study.

This article does not contain any studies with human participants or animals performed by any of the authors.

Consent Statements

Non-applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ponce de León-Ballesteros, G., Sánchez-Aguilar, H., Aguilar-Salinas, C.A. et al. Improvement of the 10-Year Atherosclerotic Cardiovascular Disease (ASCVD) Risk Following Bariatric Surgery. OBES SURG 30, 3997–4003 (2020). https://doi.org/10.1007/s11695-020-04770-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-020-04770-3

Keywords

Navigation