Weight loss after bariatric surgery may improve CV structure, function
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Weight loss after bariatric surgery may drive marked improvements in cardiac structure and function due to reductions in visceral fat, including left ventricular reverse remodeling and reduced ventricular interaction, researchers reported.
“Obesity is incredibly common in the U.S. and has become the leading cause of HF with preserved ejection fraction, a disease with few effective treatments,” Barry A. Borlaug, MD, consultant in the department of cardiovascular medicine at Mayo Clinic, told Healio. “This study shows that significant weight loss sustained over a chronic duration improves many of the cardiac abnormalities that are responsible for HFpEF, and the degree of improvement is strongly tied to reduction in body fat and, particularly, visceral fat.”
Cardiometabolic improvements after weight loss
In a retrospective, observational study, Borlaug and colleagues analyzed data from 213 adults with obesity who underwent echocardiography before and 180 days after undergoing bariatric surgery at Mayo Clinic from 2008 to 2017. Select participants (n = 52) also underwent CT to assess abdominal visceral adipose tissue (VAT). The mean age of participants was 54 years; mean BMI was 45 kg/m2 and 67% were women. Researchers evaluated the effects of long-term weight loss after bariatric surgery on cardiac structure, function, ventricular interaction and body composition, including epicardial adipose thickness and abdominal VAT. Mean follow-up was 5.3 years.
The findings were published in the Journal of the American College of Cardiology.
Across the cohort, mean BMI decreased by 22% during follow-up (P < .0001), with accompanying favorable reductions in BP, fasting glucose and left ventricular remodeling. Epicardial adipose thickness was also reduced by a mean of 14% (P < .0001) in tandem with reductions in ventricular interdependence, according to the researchers.
LV and right ventricular longitudinal strain improved after weight loss; however, left atrial strain deteriorated while left atrial volume and estimated left atrial pressures increased.
In subgroup analysis, LV wall thickness and strain correlated more strongly with VAT than with baseline BMI; reductions in LV mass after surgery were correlated with decreases in VAT, but not BMI.
Among participants who underwent CT, VAT area decreased by 30% (P < .0001).
“These findings suggest that weight loss could be a treatment for people with obesity and HFpEF, and these data also underline the importance of weight loss to reduce the risk for developing HFpEF,” Borlaug told Healio. “At this point, new studies need to test weight-loss interventions as part of randomized trials. These may involve lifestyle, or a combination of lifestyle and medical treatments or surgical interventions. Such studies would ideally take place with people with HFpEF, to test treatment, and also involve people at risk for developing HFpEF.”
Greater CV risk with visceral fat
In an accompanying editorial, Paul A. Heidenreich, MD, MS, professor in the department of medicine at Stanford University School of Medicine and the VA Palo Alto Health Care System, California, noted the data provide additional evidence of the greater cardiac risk of visceral vs. subcutaneous adipose tissue.
“Although BMI will still have prognostic value, measures of central obesity are more likely to be predictive of cardiac structural changes and events and should be routinely reported by obesity research studies,” Heidenreich said.
Heidenreich wrote that high-quality observational data “will continue to be necessary” to further understand obesity’s cardiac effects and guide patients and clinicians in the best choice of treatment.
Reference:
For more information:
Barry A. Borlaug, MD, can be reached at borlaug.barry@mayo.edu.
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