Thirty‐Year Risk of Cardiovascular Disease Events in Adolescents with Severe Obesity

Abstract

Objective Quantifying risk for cardiovascular disease (CVD) events among adolescents is difficult owing to the long latent period between risk factor development and disease outcomes. This study examined the 30‐year CVD event risk among adolescents with severe obesity treated with and without metabolic and bariatric surgery (MBS), compared with youths with moderate obesity, overweight, or normal weight. Methods Cross‐sectional and longitudinal comparisons of five frequency‐matched (age and diabetes status) groups were performed: normal weight (n = 247), overweight (n = 54), obesity (n = 131), severe obesity without MBS (n = 302), and severe obesity undergoing MBS (n = 215). A 30‐year CVD event score developed by the Framingham Heart Study was the primary outcome. Data are mean (SD) with differences between time points for MBS examined using linear mixed models. Results Preoperatively, the likelihood of CVD events was higher among adolescents undergoing MBS (7.9% [6.7%]) compared with adolescents with severe obesity not referred for MBS (5.5% [4.0%]), obesity (3.9% [3.0%]), overweight (3.1% [2.4%]), and normal weight (1.8% [0.8%]; all P < 0.001). At 1 year after MBS, event risk was significantly reduced (7.9% [6.7%] to 4.0% [3.4%], P < 0.0001) and was sustained for up to 5 years after MBS (P < 0.0001, all years vs. baseline). Conclusions Adolescents with severe obesity are at elevated risk for future CVD events. Following MBS, the predicted risk of CVD events was substantially and sustainably reduced.

Update on Metabolic Bariatric Surgery for Morbidly Obese Adolescents

“…In the follow-up of Adolescent Bariatric Surgery 5+ (FABS-5+) study, it has been shown that the values of all lipids, except for total cholesterol, eight years after gastric bypass significantly improved compared to their preoperative values [ 33 ]. Ryder et al demonstrated that in adolescents with severe obesity undergoing bariatric/metabolic surgery, the risk of hard cardiovascular endpoints was extensively improved later in life [ 5 ]. Furthermore, these data suggest that surgery in adolescents with severe obesity is cost-effective by preventing later cardiovascular events including early cardiovascular deaths [ 5 ].…”

“…Ryder et al demonstrated that in adolescents with severe obesity undergoing bariatric/metabolic surgery, the risk of hard cardiovascular endpoints was extensively improved later in life [ 5 ]. Furthermore, these data suggest that surgery in adolescents with severe obesity is cost-effective by preventing later cardiovascular events including early cardiovascular deaths [ 5 ]. These findings are comparable to long-term outcome data in adults after MBS [ 34 , 35 , 36 , 37 ].…”

“…Similar to adults, excess adipose tissue triggers multiple immunological and metabolic pathways resulting in serious comorbidities including disturbed glucose metabolism leading to prediabetes or type 2 diabetes, non-alcoholic fatty liver disease, renal disease, hyperlipidemia, and hyperuricemia [ 2 , 3 , 4 ]. In addition, adolescents with severe obesity seem to present a pronounced risk for developing major cardiovascular morbidities in early adulthood [ 5 ]. Furthermore, orthopedic problems as well as obstructive sleep apnea syndrome often already exist in these children [ 6 ].…”

Impact of Pediatric Obesity on Diurnal Blood Pressure Assessment and Cardiovascular Risk Markers

“…Furthermore, the Princeton Follow-up study has shown that pediatric hypertriglyceridemia can predict cardiovascular disease events in the fourth to fifth decade of life ( 47 ). A recent study utilizing CVD prediction algorithms from clinical data including serum lipids, systolic blood pressure, diabetes status, and BMI demonstrated that adolescents with severe obesity have a significant risk of having a cardiovascular event before the age of 50; however, after undergoing bariatric surgery, the predicted risk of CVD events was significantly reduced ( 48 ). Extrapolating these results into our own findings suggests that with severity of obesity, the likelihood of a cardiovascular event in adulthood is increased.…”

Lipid Inhibitory Effect of (−)-loliolide Isolated from Sargassum horneri in 3T3-L1 Adipocytes: Inhibitory Mechanism of Adipose-Specific Proteins

“…Obesity is regarded as a public health problem, and the overweight and obese populations are steadily increasing [ 33 ]. Most importantly, the prevalence of obesity-related complications has also grown in the past few decades [ 34 , 35 , 36 ]. Epidemiological obesity studies have revealed that overweight and obese individuals worldwide account for 33% of the total population [ 37 ].…”