title: Cardiovascular risk after bariatric surgery for obesity.
abstract: Obese patients have an increased prevalence of cardiovascular (CV) risk factors, which improve with bariatric surgery, but whether bariatric surgery reduces long-term CV events remains ill defined. A systematic review of published research was conducted, and CV risk models were applied in a validation cohort previously published. A standardized MEDLINE search using terms associated with obesity, bariatric surgery, and CV risk factors identified 6 test studies. The validation cohort consisted of a population-based, historical cohort of 197 patients who underwent Roux-en-Y gastric bypass and 163 control patients, identified through the Rochester Epidemiology Project. Framingham and Prospective Cardiovascular Munster Heart Study (PROCAM) risk scores were applied to calculate 10-year CV risk. In the validation cohort, absolute 10-year Framingham risk score for CV events was lower at follow-up in the bariatric surgery group (7.0% to 3.5%, p <0.001) compared with controls (7.1% to 6.5%, p = 0.13), with an intergroup absolute difference in risk reduction of 3% (p <0.001). PROCAM risk in the bariatric surgery group decreased from 4.1% to 2.0% (p <0.001), whereas the control group exhibited only a modest decrease (4.4% to 3.8%, p = 0.08). Using mean data from the validation study, the trend and directionality in risk was similar in the Roux-en-Y group. The test studies confirmed the directionality of CV risk, with estimated relative risk reductions for bariatric surgery patients ranging from 18% to 79% using the Framingham risk score compared with 8% to 62% using the PROCAM risk score. In conclusion, bariatric surgery predicts long-term decreases in CV risk in obese patients.
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. john.batsis@gmail.com
authors.forename: John A
authors.initials: JA
authors.lastname: Batsis
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
authors.forename: Maria L
authors.initials: ML
authors.lastname: Collazo-Clavell
authors.forename: Randal J
authors.initials: RJ
authors.lastname: Thomas
authors.forename: Abel
authors.initials: A
authors.lastname: Romero-Corral
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology*; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D012307:Risk Factors; D018709:Statistics, Nonparametric