Bariatric surgery and cardiovascular outcome

Abstract

Background Obesity is recognized as a classic risk factor for atherosclerosis and subsequent cardiovascular disease (CVD). Weight loss after bariatric surgery has been associated with reduced CV mortality and total mortality in obese patients. Our aim was to study the impact of bariatric surgery on CV risk profile, cardiac structure, and function postoperatively. Results This prospective longitudinal study included 100 morbidly obese patients at final analysis. All patients were subjected to full clinical, laboratory, and echocardiographic examination at baseline and 6 months after bariatric surgery. The mean age of study population was 37.2 ± 10.49 with BMI of 47 ± 6.82. Females represented 84%. Sleeve gastrectomy and Roux-en-Y gastric bypass were performed in 79% and 21%, respectively. Surgery-related mortality and morbidity were 0.94% and 4.7%, respectively. After 6 months, there were significant decreases in BMI, heart rate, SBP, DBP, and Framingham risk score (P < 0.0001). The prevalence of risk factors decreased as follows: hypertension 24% vs. 12%, P = 0.0005; DM 21% vs. 11%, P = 0.002; dyslipidemia 32% vs. 7%, P < 0.0001; and metabolic syndrome 54% vs. 26%, P < 0.0001. Highly significant (P < 0.0001) decrease in fasting PG and 2 h PP-PG, HbA1c, ASL, ALT, fasting total cholesterol, LDL, TG, and increase in HDL were observed after bariatric surgery. There were significant shortening in QTc interval (P = 0.009), decrease in LV dimensions and LV mass index (P < 0.0001), and increase in LV EF% (P = 0.0003). BMI at follow-up showed significant positive correlation with age, Framingham risk score, and preoperative BMI (r = 0.289, P = 0.0036; r = 0.37, P = 0.0054; and r = 0.31, P = 0.0081, respectively). Conclusion In addition to enabling patients to achieve a substantial weight loss, bariatric surgery provides a myriad of health benefits. Weight reduction was associated with a favorable improvement in cardiovascular risk profile, cardiac structure, and function.

Pathophysiological mechanisms and clinical evidence of relationship between Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease

“…Moreover, in these patients it has been reported an improvement of biochemical parameters (e.g., AST/ALT) [192]. Some authors suggest that the beneficial effect could also improve the CV profile, however there is still no clear evidence on this point and future studies are required to better define this association [193,194].…”

Metabolomic signatures after bariatric surgery – a systematic review

“…The differences observed in sulfate-containing metabolites’ results could easily be justified by the fact that the major group of sulfate-reducing bacteria is mainly present in the duodenum, which is trespassed in RYGB [ 76 ]. Contrary, the effects of RYGB in TMAO levels are not well understood and unexpected because high TMAO levels have been linked to cardiovascular diseases, whereas RYGB is known to reduce the cardiovascular risk and events [ 77 , 78 ]. The increase in TMAO levels observed after RYGB, but not after SG, could be explained by the shortening of the small bowel and a less anaerobic metabolism by the gut microbiota, in result of the increase in microbes, such as E.coli and Pseudomonas, responsible for raising TMAO levels [ 79 ].…”

The Impact of Bariatric Surgery on Cardiovascular Risk Factors and Outcomes: A Systematic Review

“…Changes in heart function and structure, both systolic and diastolic, have been observed following bariatric surgery [ 19 ]. In the study by Cuspidi et al, bariatric surgery demonstrated to induce the following in obese patients with preserved LV function: (1) notable depletion of absolute LVM where the LVM was indexed to body surface area or height, and relative wall thickness (RWT) and all established indexes of LVH and LV geometry have shown to anticipate cardiovascular outcomes; (2) an increase in mitral flow E/A ratio was seen which improved LV diastolic function; (3) decrease in left atrial size, indirectly indicating a normalizing LV filling pressure and diastolic function; and (4) no remarkable changes in LVEF [ 43 ].…”

“…Ammar et al [ 19 ]: BMI, heart rate, blood pressure, diabetes, dyslipidemia, and, therefore, metabolic syndrome and Framingham risk score decreased significantly (P=0.0001) six months after surgery. HTN was 24% vs. 12% (P=0.0005), diabetes was 21% vs. 11%, (P=0.002), dyslipidemia was 32% vs. 7% (P<0.0001), and MeS was 54% vs. 26% (P=0.0001).…”

“…In addition, echocardiographic findings at six-month follow-up revealed a significant reduction in left ventricle (LV) dimensions and LV mass index (LVM) (P<0.0001), a significant increase in left ventricle ejection fraction percentage (LVEF%) (P=0.0003), and an increase in early to late mitral inflow velocity (E/A) ratio (P<0.0001). Age, Framingham risk score, and preoperative BMI had substantial positive correlations with BMI at follow-up [ 19 ].…”