Review
Effect of Bariatric Surgery on Cardiovascular Risk Profile

https://doi.org/10.1016/j.amjcard.2011.06.076Get rights and content

Obesity is associated with increased risk for cardiovascular (CV) disease (CVD) and CV mortality. Bariatric surgery has been shown to resolve or improve CVD risk factors, to varying degrees. The objective of this systematic review was to determine the impact of bariatric surgery on CV risk factors and mortality. A systematic review of the published research was performed to evaluate evidence regarding CV outcomes in morbidly obese bariatric patients. Two major databases (PubMed and the Cochrane Library) were searched. The review included all original reports reporting outcomes after bariatric surgery, published in English, from January 1950 to July 2010. In total, 637 studies were identified from the initial screen. After applying inclusion and exclusion criteria, 52 studies involving 16,867 patients were included (mean age 42 years, 78% women). The baseline prevalence of hypertension, diabetes, and dyslipidemia was 49%, 28%, and 46%, respectively. Mean follow-up was 34 months (range 3 to 155), and the average excess weight loss was 52% (range 16% to 87%). Most studies reported significant decreases postoperatively in the prevalence of CV risk factors, including hypertension, diabetes, and dyslipidemia. Mean systolic pressure reduced from to 139 to 124 mm Hg and diastolic pressure from 87 to 77 mm Hg. C-reactive protein decreased, endothelial function improved, and a 40% relative risk reduction for 10-year coronary heart disease risk was observed, as determined by the Framingham risk score. In conclusion, this review highlights the benefits of bariatric surgery in reducing or eliminating risk factors for CVD. It provides further evidence to support surgical treatment of obesity to achieve CVD risk reduction.

Section snippets

Methods

The present review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.4 We conducted a comprehensive review of all studies published in English containing data on CV outcomes, risk factors, and risk reduction in obese patients after any form of bariatric surgery. We performed an electronic search in 2 databases (PubMed and the Cochrane Library) for relevant interventional or observational studies published from January 1, 1950, to July 1,

Results

After the initial screening of titles and abstracts (n = 637), 68 were excluded, and 569 studies were reviewed to determine whether they met the inclusion criteria. Of these, 463 were excluded at this stage of the review because they were not original reports of adult bariatric populations, involved duplicate patient groups, or were substudies of larger series. On review of the remaining 106 publications in full, a further 121 studies were identified from bibliographies and related citations

Discussion

Bariatric surgery has been performed for the treatment of obesity since 1953, when Dr. Richard Varco of Minnesota performed the first jejunoileal bypass specifically to induce weight loss from malabsorption. Although fraught with nutritional complications, this procedure was noted to induce marked weight reduction, and it had a remarkable effect on circulating lipid levels in severely hyperlipidemic patients, with a 90% decrease in plasma cholesterol and an even greater (96%) reduction in

References (67)

  • P. Habib et al.

    Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis

    Am J Cardiol

    (2009)
  • M.D. Kligman et al.

    Shrinking cardiovascular risk through bariatric surgery: application of Framingham risk score in gastric bypass

    Surgery

    (2008)
  • L.Y. Lin et al.

    Nitric oxide production is paradoxically decreased after weight reduction surgery in morbid obesity patients

    Atherosclerosis

    (2007)
  • A. Serra et al.

    The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up

    Clin Nutr

    (2006)
  • A. Torquati 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)
  • T.J. Anderson et al.

    Close relation of endothelial function in the human coronary and peripheral circulations

    J Am Coll Cardiol

    (1995)
  • M.C. Corretti et al.

    Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force

    J Am Coll Cardiol

    (2002)
  • R. Rossi et al.

    Prognostic role of flow-mediated dilation and cardiac risk factors in post-menopausal women

    J Am Coll Cardiol

    (2008)
  • G.A. Bray et al.

    Diet, weight loss, and cardiovascular disease prevention

    Curr Treat Options Cardiovasc Med

    (2003)
  • A. Papaioannou et al.

    Effects of weight loss on QT interval in morbidly obese patients

    Obes Surg

    (2003)
  • D. Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    Ann Intern Med

    (2009)
  • L. Sjöström et al.

    Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery

    N Engl J Med

    (2004)
  • L. Sjöström et al.

    Effects of bariatric surgery on mortality in Swedish obese subjects

    N Engl J Med

    (2007)
  • G.F. Adami et al.

    Effect of biliopancreatic diversion on hypertension in severely obese patients

    Hypertens Res

    (2005)
  • T.K. Alexandrides et al.

    Resolution of diabetes mellitus and metabolic syndrome following Roux-en-Y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity

    Obes Surg

    (2007)
  • A.R. Ahmed et al.

    Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure

    Obes Surg

    (2009)
  • J.H. Ahroni et al.

    Laparoscopic adjustable gastric banding: weight loss, co-morbidities, medication usage and quality of life at one year

    Obes Surg

    (2005)
  • W.A. Anderson et al.

    Weight loss and health outcomes in African Americans and whites after gastric bypass surgery

    Obesity (Silver Spring)

    (2007)
  • V. Bacci et al.

    Modifications of metabolic and cardiovascular risk factors after weight loss induced by laparoscopic gastric banding

    Obes Surg

    (2002)
  • J.A. Batsis et al.

    Effect of weight loss on predicted cardiovascular risk: change in cardiac risk after bariatric surgery

    Obesity (Silver Spring)

    (2007)
  • W.B. Bowne et al.

    Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis

    Arch Surg

    (2006)
  • D.R. Cottam et al.

    A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and lap-band patients in a single US center with three-year follow-up

    Obes Surg

    (2006)
  • G.S. Cowan et al.

    Significant changes in blood pressure, glucose, and lipids with gastric bypass surgery

    World J Surg

    (1998)
  • Cited by (0)

    Dr. Brethauer is a speaker, consultant, and scientific advisory board member for Ethicon Endo-Surgery, Blue Ash, Ohio; is a speaker for Covidien, Mansfield, Massachusetts; and receives research support from Davol, A Bard Company, Warwick, Rhode Island. Dr. Schauer's is a consultant and scientific advisory board member for and has received research support from Ethicon Endo-Surgery; is a member of the board of directors of RemedyMD, Sandy, Utah; is a member of the scientific advisory board of and has received an educational grant from Stryker Endoscopy, San Jose, California; is a member of the scientific advisory board and a consultant for Davol, A Bard Company; is a consultant for and has received an educational grant from W. L. Gore & Associates, Newark, Delaware; has received an educational grant from Baxter International, Deerfield, Illinois; is a member of the scientific advisory boards of BaroSense, Redwood City, California, SurgiQuest, Orange, Connecticut, and Cardinal/Snowden Pencer, Dublin, Ohio; has received an educational grant from Covidien; has received an educational grant from Allergan, Irvine, California; and is a member of the board of directors of Surgical Excellence LLC.

    Drs. Heneghan and Meron-Eldar contributed equally to this article.

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