Bariatric Surgery Impacts Cardiovascular Risk Factors

Restrictive gastric banding and other types of gastric bypass can radically and swiftly reduce risk factors for heart disease and stroke, according to a new study.

Researchers at the Cleveland Clinic (OH, USA) conducted a systematic review of three major databases (PubMed, Medline, and the Cochrane library) to quantify the impact of bariatric surgery on cardiovascular (CV) risk factors, and on cardiac structure and function. In all, 73 studies involving 19,543 subjects were included (mean age 42 years, 76% female), with a mean follow-up of 57.8 months. The baseline prevalence of hypertension, diabetes, and hyperlipidemia were 44%, 24%, and 44%, respectively; the average excess weight loss was 54%.

The results showed that postoperative improvement of hypertension occurred in 63% of subjects, of diabetes in 73%, and of hyperlipidaemia in 65%. Further echocardiographic data from another 18 studies that examined 713 subjects demonstrated statistically significant improvements in left ventricular mass, E/A ratio, and isovolumic relaxation time postoperatively. The study was published online on October 17, 2012, in Heart.

“The findings back those of previous research and raise bariatric surgery beyond the realms of a cosmetic procedure and into the realms of interventions demonstrating efficacy in preventing cardiovascular events,” concluded lead author Amanda Vest, MD, and colleagues. “The magnitude of effect on [cardiovascular] risk factors is impressive, and to date no pharmacological therapy for weight management or diabetes has shown a comparable effect over these short time periods.”

Bariatric surgery includes a variety of procedures to reduce the size of the stomach, either using an implanted medical device (gastric banding), through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch), or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery). The US National Institutes of Health (NIH) recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI 35 and serious coexisting medical conditions such as diabetes.

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