Elsevier

Surgery

Volume 143, Issue 4, April 2008, Pages 533-538
Surgery

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

https://doi.org/10.1016/j.surg.2007.10.021Get rights and content

Background

The Framingham risk score estimates 10-year coronary heart disease (CHD) risk based on gender, age, smoking status, blood pressure, TC, HDL-C, and diabetes mellitus status. It was designed to be independent of weight, and as such it is the ideal model to estimate the impact of bariatric surgery on the change in this risk. Our study evaluates the effect of gastric bypass on the prevalence of CHD risk factors and then utilizes the Framingham risk score to estimate the postoperative reduction in 10-year CHD risk.

Methods

Retrospectively, 101 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass were reviewed. The 10-year CHD risk was calculated using historic, biometric, and laboratory data.

Results

The mean body mass index decreased from 46.9 ± 5.8 kg/m2 preoperatively to 28.7 ± 4.0 kg/m2 one year postoperatively. All physical and biochemical markers of cardiac risk improved significantly. Systolic blood pressure fell from 143 ± 20 mmHg to 123 ± 18 mmHg (14%) and diastolic blood pressure fell from 81 ± 10 mmHg to 71 ± 11 mmHg (12%). Total cholesterol declined from 202 to 165 (18%); LDL-C declined from 118 to 97 (18%); and HDL-C increased from 45 to 51 (14%). The overall 10-year CHD risk decreased from 6.7 ± 5.5% to 3.2 ± 3.1%, representing an absolute risk reduction of 3.3% or relative risk reduction of 52%. This risk reduction was similar in subgroups based on preoperative CHD risk or on initial BMI.

Conclusions

Using the Framingham risk score we show that gastric bypass surgery reduces 10-year coronary risk by more than half. Additionally, to the increasing evidence of the salutary effect gastric bypass surgery has on CHD risk, we contribute assessment of 10-year risk in subjects at stable weight loss and within the Framingham model's validated parameters.

Section snippets

Material and methods

A retrospective review was undertaken of 101 consecutive patients, all having undergone laparoscopic Roux-en-Y gastric bypass by a single surgeon. Complete preoperative and 1-year postoperative data were available for 97 patients and are the basis of this report. The remaining 4 patients were living 1 year following surgery but had incomplete data sets and were excluded from further evaluation. All patients fulfilled the weight criteria recommended in the National Institutes of Health

Results

The demographic profile for patients in this study is similar to those reported in previous bariatric surgery series. The mean age of the study population was 42.5 ± 9.0 years and 89% of patients were female. The majority of patients (93%) were white; 6% were African American; and 1% was Asian. Preoperatively 17 (18%) patients were classified as smokers; postoperatively, all continued to smoke. The mean BMI decreased significantly from 46.9 ± 5.8 kg/m2 preoperatively to 28.7 ± 4.0 kg/m2 1-year

Discussion

The chief rationale for bariatric surgery from a health care perspective is the reduction in morbidity and mortality risk associated with morbid obesity. Thus, in this population the potential of bariatric surgery to reduce risk of CHD, the leading U.S. cause of death, is of paramount interest. Until recently studies have focused on bariatric surgery's impact on the major CHD risk factors. Assessment of bariatric surgery's impact on overall postoperative CHD risk reduction has been limited.

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