Effect of weight loss on predicted cardiovascular risk: change in cardiac risk after bariatric surgery.
OBJECTIVE
Our goal was to assess the effect of bariatric surgery on cardiovascular risk estimations of preventable, long-term adverse outcomes.


METHODS
We performed a population-based, historical cohort study between 1990 and 2003 of 197 consecutive patients from Olmsted County, MN, with Class II to III obesity (defined as BMI > or = 35 kg/m2) treated with Roux-en-Y gastric bypass and 163 non-operative patients assessed in a weight-reduction program. We used the observed change in cardiovascular risk factors and risk models derived from data from the National Health and Nutrition Examination Survey (NHANES) I and the NHANES I Epidemiological Follow-up Study (NHEFS) to calculate the predicted impact on cardiovascular events and mortality for the operative and non-operative groups.


RESULTS
Mean follow-up was 3.3 years. Hypertension, diabetes, and dyslipidemia all improved after bariatric surgery. The estimated 10-year risk for cardiovascular events for the operative group decreased from 37% at baseline to 18% at follow-up, while the estimated risk for the non-operative group did not change from 30% at baseline to 30% at follow-up. Risk modeling to predict 10-year outcomes estimated 4 overall deaths and 16 cardiovascular events prevented by bariatric surgery per 100 patients compared with the non-operative group.


CONCLUSIONS
Bariatric surgery induces an improvement in cardiovascular risk factors in patients with Class II to III obesity. Weight loss predicts a major, 10-year reduction in cardiovascular events and deaths. Bariatric surgery should be considered as an alternative approach to reduce cardiovascular risk in patients with Class II to III obesity.
Batsis
John A
JA
Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Romero-Corral
Abel
A
Collazo-Clavell
Maria L
ML
Sarr
Michael G
MG
Somers
Virend K
VK
Brekke
Lee
L
Lopez-Jimenez
Francisco
F
D000328:Adult; D050110:Bariatric Surgery; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D016022:Case-Control Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology*