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Reduced Risk of Cardiovascular Diseases After Bariatric Surgery Based on the New Predicting Risk of Cardiovascular
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 cardiovascular disease risk, especially heart failure, within two years. This highlights surgery as a key intervention for long-term cardiovascular health.
Area of Science:
- Cardiovascular Medicine
- Metabolic Health
- Surgical Outcomes
Background:
- Cardiovascular-kidney-metabolic (CKM) health and cardiovascular disease (CVD) risk assessment is crucial, particularly in patients undergoing bariatric surgery.
- Novel Predicting Risk of Cardiovascular Disease EVENTs (PVD) equations offer a tool to evaluate CKM health and estimate CVD risk.
Purpose of the Study:
- To evaluate CKM health and estimate CVD risk following bariatric surgery using the PVD equations.
- To assess the changes in CVD risk factors and overall CVD risk from pre-surgery to two years post-surgery.
Main Methods:
- Analysis of 7804 patients (aged 20-79) undergoing bariatric surgery between 1999-2022.
- Extraction of CVD risk factors from electronic health records pre-surgery to two years post-surgery.
- Estimation of 10- and 30-year risks for total CVD, atherosclerotic CVD, coronary heart disease, stroke, and heart failure (HF) using PVD equations.
Main Results:
- Significant improvements in CKM health observed post-surgery, including lower blood pressure, improved cholesterol profiles, and better kidney function.
- Substantial reductions in estimated 10-year CVD risks (21.7%-56.3% at 1 year, 14.6%-46.5% at 2 years), with the greatest reduction in HF risk.
- Factors like younger age, White race, significant weight loss, and diabetes history were associated with greater HF risk reduction.
Conclusions:
- Bariatric surgery leads to significant improvements in CKM health and markedly reduces estimated CVD risk, particularly for HF, within two years.
- The extent of HF risk reduction can be influenced by patient demographics, weight loss achieved, and pre-existing conditions, suggesting a need for personalized risk management.
Background:
We applied the novel Predicting Risk of Cardiovascular Disease EVENTs equations to evaluate cardiovascular-kidney-metabolic (CKM) health and estimated cardiovascular disease (CVD) risk after bariatric surgery.
Methods:
Among 7804 patients (aged 20-79 years) undergoing bariatric surgery at Vanderbilt University Medical Center during 1999 to 2022, CVD risk factors from before surgery to 2 years after surgery were extracted from electronic health records. The 10- and 30-year risks of total CVD, atherosclerotic CVD, coronary heart disease, stroke, and heart failure (HF) were estimated for patients without CVD history at each time point (n=124-2910), using the social deprivation index-enhanced Predicting Risk of Cardiovascular Disease EVENTs equations. Paired t tests or McNemar tests were used to compare pre- with postsurgery CKM health and CVD risk. Two-sample t tests were used to compare CVD risk reduction between patient subgroups.
Results:
CKM health was significantly improved after surgery with lower systolic blood pressure, non-high-density lipoprotein cholesterol, and diabetes prevalence, and higher high-density lipoprotein and estimated glomerular filtration rate. The 10-year risks of total CVD and its subtypes decreased by 21.7% to 56.3% at 1 year after surgery and by 14.6% to 46.5% at 2 years after surgery, with the largest reduction observed for HF. Younger age, White race, >30% weight loss, and diabetes history were associated with greater HF risk reductions. Similar results were found for the 30-year CVD risk estimates.
Conclusions:
Bariatric surgery significantly improves CKM health and reduces estimated CVD risk, particularly HF, by 47% to 56% within 1 to 2 years after surgery. HF risk reduction may vary by patient's demographics, weight loss, and disease history, which warrants further research.
