Risk prediction of complications of metabolic syndrome before and 6 years after gastric bypass.
BACKGROUND
Roux-en-Y gastric bypass (RYGB) surgery has been shown to have favorable effects on components of metabolic syndrome. However, the long-term effect of RYGB on predicted risk of end-organ complications is less clear. The objective of this study was to examine long-term changes in predicted risk of metabolic syndrome-related complications after RYGB.


METHODS
The predicted risk of metabolic syndrome-related complications in a cohort of 131 diabetic patients was compared between baseline and last follow-up points after RYGB using validated risk assessment tools.


RESULTS
After a median postsurgical follow-up time of 6 years (range, 5-9), a mean percent excess weight loss of 60.7 ± 25.1% was associated with a diabetes remission rate of 61%. At long-term follow-up, the levels of glycated hemoglobin, low-density lipoprotein, and blood pressure were within the recommended American Diabetes Association's goals in 85%, 73%, and 63% of patients, respectively (P<.001). RYGB was associated with a relative risk reduction of 27% for 10-year overall risk of coronary heart disease (CHD), stroke, and peripheral vascular disease; 20% for 10-year risk of CHD; 40% for 10-year risk of myocardial infarction; 42% for 10-year risk of stroke; 47% for 4-year risk of intermittent claudication; 45% for 5-year risk of moderate-severe kidney disease; and 18% for 5-year risk of cardiovascular mortality. Four-year risk of diabetic retinopathy was also significantly decreased.


CONCLUSIONS
RYGB in diabetic patients results in remarkable control of diabetes, dyslipidemia, and hypertension, and is associated with a significant reduction in predicted risk of major complications including nephropathy, retinopathy, and cardiovascular disease and mortality in the range of 18-47% at long-term follow-up.
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Ali
A
Aminian
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Christopher R
CR
Daigle
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Héctor
H
Romero-Talamás
Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio.
Sangeeta R
SR
Kashyap
Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio.
John P
JP
Kirwan
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Stacy A
SA
Brethauer
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: schauep@ccf.org.
Philip R
PR
Schauer
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
Bariatric; Cardiovascular; Diabetes; Framingham; Metabolic; Morbid obesity; Mortality; Nephropathy; Retinopathy; Risk; Roux-en-Y gastric bypass; Stroke