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.
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.
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.
Surgically induced weight loss leads to a significant improvement in the estimated 10-year ASCVD risk, 1 year after surgery.
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Atherosclerotic cardiovascular disease
Body mass index
Coronary artery calcium score
Excess body weight loss
Framingham risk score
High-density lipoprotein cholesterol
Carotid intima-media thickness
Low-density lipoprotein cholesterol
Mitral annular plane systolic excursion
Roux-en-Y gastric bypass
Type 2 diabetes mellitus
Tricuspid annular plane systolic excursion
Total weight loss
Engin A. The definition and prevalence of obesity and metabolic syndrome. In: Adv Exp Med Biol; 2017. p. 1–17.
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.
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.
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.
Global Health Estimates. Deaths by cause, age, sex, by country and by region, 2000-2016, vol. 2018. Geneva: World Health Organization; 2016.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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
- Cardiovascular risk
- Bariatric surgery
- Total cholesterol
- Systolic blood pressure
- Roux-Y gastric bypass
- Sleeve gastrectomy