title: Changes in predicted cardiovascular disease risk after biliopancreatic diversion surgery in severely obese patients.
abstract: OBJECTIVE
  To determine the impact of biliopancreatic diversion with duodenal switch (BPD-DS) surgery on cardiovascular risk profile and predicted cardiovascular risk in severely obese patients.
  
  
  METHODS
  We compared 1-year follow-up anthropometric and metabolic profiles in severely obese who underwent BPD-DS (n = 73) with controls (severely obese without surgery) (n =3 3). The 10-year predicted risk for coronary heart disease (CHD) was estimated using the Framingham risk-tool. We assigned 10-year and lifetime predicted risks to stratify subjects into 3 groups: 1) high short-term predicted risk (≥ 10% 10-year risk or diagnosed diabetes), 2) low short-term (<10% 10-year risk)/low lifetime predicted risk or 3) low short-term/high lifetime predicted risk.
  
  
  RESULTS
  During the follow-up period, body weight and body mass index decreased markedly in the surgical group (-52.1 ± 1.9 kg and -19.0 ± 0.6 kg/m(2) respectively, p<0.001) vs. (-0.7 ± 1.0 kg and -0.3 ± 0.4 kg/m(2), p = 0.51). Weight loss in the surgical group was associated with a reduction in HbA1C (6.2% vs. 5.1%), HOMA-IR (61.5 vs. 9.3), all lipoprotein levels, as well as blood pressure (p<0.001). The 10-year CHD predicted risk decreased by 43% in women and 33% in men, whereas the estimated CHD risk in the non surgical group did not change. Before surgery, none of the women and only 18% of men showed low short-term/low lifetime predicted risk, whereas a significant proportion of subjects had high short-term predicted risk (36% in women and 12% in men). Following surgery, 52% of women and 55% of men have a low short-term/low lifetime predicted risk.
  
  
  CONCLUSIONS
  These results highlight the cardiovascular benefits of BPD-DS and suggest a positive impact on predicted CHD risk in severely obese patients. Long-term studies are needed to confirm our results and to ascertain the effects on CHD risk estimates after BPD-DS surgery.
authors.affiliation: Quebec Heart and Lung Institute/Laval University, Québec, Canada.
authors.forename: Marie-Ève
authors.initials: MÈ
authors.lastname: Piché
authors.forename: Julie
authors.initials: J
authors.lastname: Martin
authors.forename: Katherine
authors.initials: K
authors.lastname: Cianflone
authors.forename: Marjorie
authors.initials: M
authors.lastname: Bastien
authors.forename: Simon
authors.initials: S
authors.lastname: Marceau
authors.forename: Simon
authors.initials: S
authors.lastname: Biron
authors.forename: Frédéric-Simon
authors.initials: FS
authors.lastname: Hould
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001053:Apolipoproteins / Q000097:blood; D015904:Biliopancreatic Diversion; D015415:Biomarkers / Q000097:blood*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D000960:Hypolipidemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents; D001053:Apolipoproteins; D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D007328:Insulin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human
keywords: ATP III; Adult Treatment Panel III; BMI; BPD-DS; Bariatric surgery; Biliopancreatic diversion with duodenal switch; Body mass index; CHD; CVD; Cardiovascular disease; Cardiovascular risk; Coronary heart disease; HOMA insulin resistance model; HOMA-IR; High sensitive C-reactive protein; Hs-CRP; Metabolic profile; NIH; National Institute of Health; SOS; Severely obese; Swedish Obese Subjects group