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Bariatric surgery and cardiovascular outcomes: a systematic review
  1. Amanda R Vest1,
  2. Helen M Heneghan2,
  3. Shikhar Agarwal1,
  4. Philip R Schauer2,3,
  5. James B Young1,3
  1. 1Heart and Vascular Institute, Cleveland Clinic, Ohio, USA
  2. 2Bariatric and Metabolic Institute, Cleveland Clinic, Ohio, USA
  3. 3Endocrinology and Metabolism Institute, Cleveland Clinic, Ohio, USA
  1. Correspondence to Dr James Young, Cleveland Clinic, Mail Code NA21, 9500 Euclid Avenue, Cleveland, OH 44195, USA; youngj{at}ccf.org

Abstract

Purpose To quantify the impact of bariatric surgery on cardiovascular (CV) risk factors, and on cardiac structure and function.

Data sources Three major databases (PubMed, Medline and Cochrane) were searched for original studies written in English.

Study selection Original articles reporting CV risk factors or non-invasive imaging parameters for patients undergoing bariatric surgery, from January 1950 to June 2012.

Data extraction Data extraction from selected studies was based on protocol-defined criteria that included study design, methods, patient characteristics, surgical procedures, weight loss, changes in CV risk factors, cardiac structure and cardiac function postoperatively.

Data synthesis 73 CV risk factor studies involving 19 543 subjects were included (mean age 42 years, 76% female). Baseline prevalence of hypertension, diabetes and hyperlipidaemia were 44%, 24%, and 44%, respectively. Mean follow-up was 57.8 months (range 3–176) and average excess weight loss was 54% (range 16–87%). Postoperative resolution/improvement of hypertension occurred in 63% of subjects, of diabetes in 73% and of hyperlipidaemia in 65%. Echocardiographic data from 713 subjects demonstrated statistically significant improvements in left ventricular mass, E/A ratio, and isovolumic relaxation time postoperatively.

Limitations Diagnostic criteria, CV risk factor reporting, and imaging parameters were not uniform across all studies. Study groups were heterogeneous in their demographics, operative technique and follow-up period.

Conclusions This systematic review highlights the benefits of bariatric surgery in reducing risk factors for CV disease. There is also evidence for left ventricular hypertrophy regression and improved diastolic function. These observations provide further evidence that bariatric surgery enhances future CV health for obese individuals.

  • Basic science
  • oxidative stress
  • cardiac function
  • systolic dysfunction
  • heart failure
  • heart failure treatment
  • metabolic medicine
  • diabetic heart disease
  • cardiomyopathy
  • valvular disease
  • cardiac surgery
  • heart transplant
  • artificial heart

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Footnotes

  • Disclosures The authors did not receive funding for this work. PRS disclosures include: Ethicon Endo-Surgery: consultant, scientific advisory board member, research support; Remedy MD: board of directors; Stryker Endoscopy: scientific advisory board, educational grant; Bard/Davol: scientific advisory board, consultant; Gore: consultant, educational grant; Baxter: educational grant; Barosense, Surgiquest, Cardinal/Snowden Pencer: scientific advisory board; Covidien: educational grant; Allergan: educational grant; Surgical Excellence LLC: board of directors. No other authors have any financial disclosures. The authors would like to disclose that this systematic review expands upon a preliminary review of this topic published by Heneghan et al in Am J Cardiol 2011.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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