Cardiometabolic Improvements After Metabolic Surgery and Related Presurgery Factors

Abstract

Context Metabolic surgery remains the most effective and durable treatment for severe obesity and related metabolic diseases. Objective We examined cardiometabolic improvements after metabolic surgery and associated presurgery demographic and clinical factors in a large multiracial cohort. Methods Included were 7804 patients (20-79 years) undergoing first-time metabolic surgery at Vanderbilt University Medical Center from 1999 to 2022. Pre- and 1-year postsurgery cardiometabolic profiles were extracted from medical records, including body mass index (BMI), blood pressure, blood lipids, glucose, and hemoglobin A1c. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk was estimated per American College of Cardiology/American Heart Association equations. Pre- to postsurgery cardiometabolic profiles were compared by paired t-test, and associated factors were identified by multivariable linear and logistic regression. Results Among 7804 patients, most were women and White, while 1618 were men and 1271 were Black; median age and BMI were 45 years [interquartile range (IQR): 37-53] and 46.4 kg/m2 (IQR: 42.1-52.4). At 1-year postsurgery, patients showed significant decreases in systolic blood pressure (10.5 [95% confidence interval: 10.1, 10.9] mmHg), total cholesterol (13.5 [10.3, 16.7] mg/dL), glucose (13.6 [12.9, 14.4] mg/dL), hemoglobin A1c (1.13% [1.06, 1.20]), and 10-year ASCVD risk (absolute reduction: 1.58% [1.22, 1.94]; relative reduction: 34.4% [29.4, 39.3]); all P < .0001. Older, male, or Black patients showed less reduction in 10-year ASCVD risk and lower odds of diabetes/hypertension/dyslipidemia remission than younger, female, or White patients. Patients with a history of diabetes, hypertension, dyslipidemia, or cardiovascular disease showed less cardiometabolic improvements than those without. Results were similar with or without further adjusting for weight loss and largely sustained at 2-year postsurgery. Conclusion Metabolic surgery results in significant cardiometabolic improvements, particularly among younger, female, or White patients and those without comorbidities.

Reduced Risk of Cardiovascular Diseases after Bariatric Surgery Based on the New PREVENT Equations

“…Our findings on CKM health improvements were consistent with the literature and results reported in our recent publication, which showed significant reductions in blood pressure, blood lipids, glucose, and HbA1c, as well as 32% to 50% remissions rates of diabetes, hypertension, and dyslipidemia 1 year after bariatric surgery. 11,24,9 In addition, we observed 28% and 19% reductions in 10-year ASCVD risk at 1and 2-year post-surgery, which is in line with previous reports, ranging from 19% to 54%, 16 although the reductions appear to be smaller than our previous results based on the ACC/AHA equations (34% and 23%). 9 This discrepancy could be explained by differences in those CVD risk prediction models.…”

“…11,24,9 In addition, we observed 28% and 19% reductions in 10-year ASCVD risk at 1and 2-year post-surgery, which is in line with previous reports, ranging from 19% to 54%, 16 although the reductions appear to be smaller than our previous results based on the ACC/AHA equations (34% and 23%). 9 This discrepancy could be explained by differences in those CVD risk prediction models. The new PREVENT equations were derived among >6 million people aged 30-79 years from 46 cohorts, 22 while the ACC/AHA equations were race-specific risk prediction models developed in ~25,000 non-Hispanic White and Black people aged 40-79 years from only 5 cohorts.…”

“…This study was conducted in the bariatric surgery cohort at VUMC, consisting of 7804 patients who were 20 to 79 years old and underwent their first bariatric surgery between January 1999 and July 2022. 9,23 Pre-and post-surgery data over 1 to 120 months at 3-month intervals were collected in the Vanderbilt Metabolic and Bariatric Surgery Quality, Efficacy, and Safety (QES) database, including demographics (e.g., age, sex, and race), surgery information (e.g., surgery date, surgeon, and operation type), disease history (e.g., diabetes, hypertension, and dyslipidemia), and clinical outcomes (e.g., body weight, body mass index [BMI], and HbA1c).…”

“…Bariatric surgery leads to a 30% weight loss while reducing hemoglobin A1c (HbA1c) by 0.3% to 2.7%, systolic blood pressure (SBP) by 7.2 to 15.1 mmHg, and total cholesterol (TG) by 21.6 to 66.7 mg/dL and increasing estimated glomerular filtration rate (eGFR) by an average of 14.27 ml/min/1.73 m 2 at 1-year post-surgery. [5][6][7][8][9][10] In addition, bariatric surgery achieves remission rates ranging from 33% to 90% for diabetes, 43% to 83% for hypertension, 16% to 80% for dyslipidemia at 1-year post-surgery, and 77% to 83% for albuminuria at 6-12 months. [11][12][13][14][15] Regarding the risk of future CVD events, we recently reported a ~34% reduction in 10year atherosclerotic CVD (ASCVD) risk, in line with a 2020 review noting a 19% to 54% relative reduction in 10-year CVD risk one year after bariatric surgery.…”

“…[11][12][13][14][15] Regarding the risk of future CVD events, we recently reported a ~34% reduction in 10year atherosclerotic CVD (ASCVD) risk, in line with a 2020 review noting a 19% to 54% relative reduction in 10-year CVD risk one year after bariatric surgery. 9,16 All previous studies used well-known CVD risk models such as the Framingham Risk Score for 10-year CHD risk and the American College of Cardiology/American Heart Association (ACC/AHA) pooled cohort equations for 10-year ASCVD risk. However, previous models have not accounted for the additional risk posed by reduced renal function or socioeconomic disadvantage nor predicted HF risk.…”