Bariatric surgery tied to improved cardiometabolic health, lower CVD risk
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Key takeaways:
- Bariatric surgery was associated with reductions in body weight, blood pressure, total cholesterol, triglycerides, glucose and HbA1c.
- Adults who underwent surgery reduced their 10-year ASCVD risk by 34.4%.
Adults with obesity who underwent bariatric surgery had improvements in multiple cardiometabolic measures after surgery, according to findings published in the Journal of the Endocrine Society.
Researchers assessed cardiometabolic changes among a large group of adults who underwent bariatric surgery at Vanderbilt University Medical Center in Nashville, Tennessee. At 1 year after surgery, adults had reductions in body weight, blood pressure, LDL and total cholesterol, triglycerides, glucose and HbA1c as well as an increase in HDL cholesterol.
“Our study shows that bariatric surgery leads to substantial cardiometabolic health improvement, including an estimated 35% reduction in predicted 10-year cardiovascular disease risk 1 year after surgery,” Danxia Yu, PhD, associate professor in the division of epidemiology at Vanderbilt University Medical Center, told Healio.
Yu and colleagues obtained data from 7,804 adults aged 20 to 79 years who underwent bariatric surgery from 1999 to July 2022 (median age, 45 years; 79.3% women; 81.3% white). Surgery data were obtained from the Vanderbilt Metabolic and Bariatric Surgery Quality, Efficacy and Safety database. Data from before and after surgery were collected from electronic health records. Cardiometabolic outcomes before surgery were defined as the median value of measurements collected 6 months to 1 week before surgery. Outcomes after surgery were the median value of measurements collected 9 to 15 months after surgery. Disease remission was defined as having no diagnosis, no medication use and normal laboratory values after surgery after being diagnosed with a disease or receiving treatment for a disease before surgery.
Of the study group, 67.6% underwent Roux-en-Y gastric bypass and 26.9% had a sleeve gastrectomy performed. Before surgery, 43.3% of the group had diabetes, 77.1% had hypertension, 47.8% had dyslipidemia and 10.6% had CVD.
One year after surgery, adults had a median reduction in body weight of 41.9 kg, a 10.5 mm Hg decrease in systolic BP, a 4.9 mm Hg decrease in diastolic BP and 5.5 mm Hg decline in pulse pressure, a 13.5 mg/dL decrease in total cholesterol, a 10.3 mg/dL reduction in LDL cholesterol, a 9.9 mg/dL increase in HDL cholesterol, a 66.7 mg/dL drop in triglycerides, a 13.6 mg/dL decrease in glucose and a 1.13 percentage point decrease in HbA1c. The 10-year atherosclerotic CVD (ASCVD) risk dropped by 34.4% after surgery compared with before surgery.
Among adults with diabetes before surgery, 31.7% achieved remission at 1 year. Hypertension remission was achieved by 35.6% of adults with hypertension before surgery, and 49.6% of those with dyslipidemia before surgery had remission at 1 year.
In a mutually adjusted linear model, each 5 years of older age was associated with less of a reduction in body weight, systolic BP and 10-year ASCVD risk. Older adults were also less likely to achieve disease remission than younger adults. Men had less of a reduction in body weight, systolic BP and ASCVD risk, and less improvement in glucose and HDL cholesterol, but more of an improvement in triglycerides than women. Black adults had less improvement in body weight, systolic BP and 10-year ASCVD risk, but greater improvement in HDL cholesterol and triglycerides than white adults. Black adults also had lower odds of achieving hypertension remission than white adults.
“These findings may help inform which patients may require extra health management after surgery,” Yu said.
Yu said more studies with a longer postsurgical follow-up and more diverse patient populations are needed.
For more information:
Danxia Yu, PhD, can be reached at danxia.yu@vumc.org.
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