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Reduced Risk of Cardiovascular Diseases after Bariatric Surgery Based on the New PREVENT Equations
Lei Wang1, Xinmeng Zhang2, You Chen3
1Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Insights
Bariatric surgery significantly improves cardiovascular-kidney-metabolic health and reduces heart failure risk by over 50% within two years. These improvements highlight surgery
Area of Science:
- Cardiovascular Medicine
- Metabolic Health
- Surgical Outcomes
Background:
- Bariatric surgery is increasingly performed, necessitating evaluation of its long-term impact on cardiovascular-kidney-metabolic (CKM) health.
- Cardiovascular disease (CVD) remains a significant concern, and its risk stratification is crucial, especially post-bariatric procedures.
Purpose of the Study:
- To assess the impact of bariatric surgery on CKM health and estimate changes in CVD risk, including heart failure (HF).
- To utilize the novel Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations for risk assessment in this population.
Main Methods:
- Retrospective analysis of 7804 patients undergoing bariatric surgery from 1999-2022.
- Extracted pre- and post-surgery CVD risk factors (systolic blood pressure, cholesterol, eGFR, etc.).
- Applied social deprivation index-enhanced PREVENT equations to estimate 10- and 30-year risks for total CVD, ASCVD, CHD, stroke, and HF.
Main Results:
- Significant improvements in CKM health observed post-surgery, including lower blood pressure, non-HDL cholesterol, and diabetes prevalence, alongside higher HDL and eGFR.
- 10-year total CVD risk decreased by 25.9% at 1 year and 16.8% at 2 years post-surgery.
- Heart failure risk showed the most substantial reduction (55.7% at 1 year, 44.8% at 2 years), with variations noted across patient subgroups.
Conclusions:
- Bariatric surgery markedly enhances CKM health and substantially reduces estimated CVD risk, particularly for HF.
- The magnitude of HF risk reduction varies based on patient demographics, weight loss achievement, and pre-existing conditions, suggesting areas for further investigation.
Background:
We applied the novel Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations to evaluate cardiovascular-kidney-metabolic (CKM) health and estimated CVD risk, including heart failure (HF), after bariatric surgery.
Methods:
Among 7804 patients (20-79 years) undergoing bariatric surgery at Vanderbilt University Medical Center during 1999-2022, CVD risk factors at pre-surgery, 1-year, and 2-year post-surgery were extracted from electronic health records. The 10- and 30-year risks of total CVD, atherosclerotic CVD (ASCVD), coronary heart disease (CHD), stroke, and HF were estimated for patients without a history of CVD or its subtypes at each time point, using the social deprivation index-enhanced PREVENT equations. Paired t-tests or McNemar tests were used to compare pre- with post-surgery CKM health and CVD risk. Two-sample t-tests were used to compare CVD risk reduction between patient subgroups defined by age, sex, race, operation type, weight loss, and history of diabetes, hypertension, and dyslipidemia.
Results:
CKM health was significantly improved after surgery with lower systolic blood pressure, non-high-density-lipoprotein cholesterol (non-HDL), and diabetes prevalence, but higher HDL and estimated glomerular filtration rate (eGFR). The 10-year total CVD risk decreased from 6.51% at pre-surgery to 4.81% and 5.08% at 1- and 2-year post-surgery (relative reduction: 25.9% and 16.8%), respectively. Significant risk reductions were seen for all CVD subtypes (i.e., ASCVD, CHD, stroke, and HF), with the largest reduction for HF (relative reduction: 55.7% and 44.8% at 1- and 2-year post-surgery, respectively). Younger age, White race, >30% weight loss, diabetes history, and no dyslipidemia history were associated with greater HF risk reductions. Similar results were found for the 30-year risk estimates.
Conclusions:
Bariatric surgery significantly improves CKM health and reduces estimated CVD risk, particularly HF, by 45-56% within 1-2 years post-surgery. HF risk reduction may vary by patient's demographics, weight loss, and disease history, which warrants further research.
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