Risk assessments predict improved long-term outcomes after bariatric surgery

Bariatric surgery is associated with a significant long-term reduction in obesity’s major complications, such as coronary heart disease, cerebrovascular and peripheral vascular diseases, nephropathy, retinopathy, and cardiovascular mortality, according to researchers at Obesity Week 2013.

Validated assessment tools from Framingham, UKPDS, PROCAM, ARIC, DECODE, QKidney, and Semeraro’s nomogram were used to predict these risks, Stacy A. Brethauer, MD, staff physician in the section of laparoscopic and bariatric surgery at Cleveland Clinic, told Endocrine Today.

Stacy A. Brethauer

“We applied these risk prediction tools to patients before surgery and again after long-term follow-up and found that both micro- and macrovascular complication risk decreased significantly for all of the risk predictive tools that we used,” Brethauer said.

Patients (mean age, 48.3 years) with diabetes and obesity without CVD who underwent gastric bypass had a mean BMI of 48.9 and mean duration of diabetes of 6.4 years at baseline.

The mean percent excess weight loss of 60.7% observed 6 years after surgery was tied to a diabetes remission rate of 61%, according to data. In addition, long-term data suggest HbA1c (85%), LDL (73%) and blood pressure (61%) were within the recommended goals.

“About half of the patients had partial or complete remission, and another 30% had improvements in their diabetes in the long term. Therefore, we changed the course of that disease, but we also changed the risk of these patients developing myocardial infarction, stroke, claudication, nephropathy and retinopathy based on these predictive tools,” Brethauer said.

Bariatric surgery was associated with the following long-term relative risk reductions:

10-year overall risk for CHD, cerebrovascular and peripheral vascular disease (27%; P<.001);
10-year risk for CHD (20%; P=.002);
10-year risk for MI (40%; P<.001);
10-year risk for stroke (42%; P<.001);
5-year risk for moderate-severe kidney disease (45%; P<.001);
5-year risk for CV mortality (18%; P=.048);
4-year risk for intermittent claudication (47%; P<.001).

Moving forward, Brethauer said it is important to measure these risk factors and hard endpoints in the long term after surgery to definitively confirm that these micro- and macrovascular diseases are improving as expected. – by Samantha Costa

For more information:

Aminian A. Abstract A-102-OR. Presented at: Obesity Week; Nov. 11-15, 2013; Atlanta.

Disclosure: The researchers reported no relevant financial disclosures.

ObesityWeek

Risk assessments predict improved long-term outcomes after bariatric surgery