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Cardiometabolic Health and Bariatric Surgery: A 25-Year Longitudinal Cohort Study in CARDIA Participants
Brian T Steffen1, Sayeed Ikramuddin2, David R Jacobs3
1From the Division of Computational Health Sciences, Department of Surgery, University of Minnesota School of Medicine, Minneapolis, MN.
Insights
Bariatric surgery (BarS) patients maintained better cardiometabolic health long-term compared to matched controls, showing improved glucose, insulin, and cholesterol levels. BarS is linked to reduced diabetes incidence, indicating lasting health benefits beyond weight loss.
Area of Science:
- Cardiology
- Metabolic Health
- Bariatric Surgery Outcomes
Background:
- Bariatric surgery (BarS) effectively reduces weight and improves cardiometabolic health.
- Long-term cardiometabolic health post-BarS relative to weight status is not fully understood.
Purpose of the Study:
- To compare longitudinal cardiometabolic health outcomes in patients who underwent BarS versus matched nonsurgical controls.
- To assess if BarS patients achieve sustained cardiometabolic health aligned with their lower weight.
Main Methods:
- A cohort study matched 94 BarS patients with 282 nonsurgical controls based on sex and BMI.
- Mixed models analyzed differences in cardiometabolic endpoints, diabetes, and metabolic syndrome incidence.
- Adjustments were made for age, sex, race, field center, and education.
Main Results:
- At ~7.5 years post-BarS, patients had higher BMIs but significantly lower glucose, insulin, LDL cholesterol, and insulin resistance.
- BarS patients exhibited higher HDL cholesterol and lower C-reactive protein levels.
- The incidence of diabetes was significantly lower in the BarS group (1.8% vs. 11.7%).
Conclusions:
- No evidence of lasting adverse cardiometabolic effects from severe obesity in BarS patients.
- BarS patients demonstrated superior cardiometabolic health compared to matched controls.
- BarS offers sustained cardiometabolic benefits beyond initial weight loss.
Objective:
Compare longitudinal cardiometabolic health outcomes among individuals who underwent bariatric surgery (BarS) with nonsurgical controls.
Background:
BarS is well-established for inducing profound weight loss and improving cardiometabolic health, but it remains unclear whether patients achieve long-term cardiometabolic health consistent with the attained lower weight status.
Methods:
Cohort study participants who underwent any BarS procedure between 1987 and 2021 (n = 94) were paired with sex- and body mass index (BMI)-matched nonsurgical controls (n = 282) at the nearest postoperative cohort exam visit (2.8 ± 1.7 years following surgery). A mixed model tested differences between BarS cases and nonsurgical matched controls, adjusting for age, sex, race, field center, and maximal education attainment. Intermediate cardiometabolic endpoints and incident diabetes and metabolic syndrome, were examined at follow-up exam visits.
Results:
Approximately 7.5 years following their procedures, those who underwent BarS showed higher BMIs than matched controls (+2.8 kg/m2); however, the BarS group showed significantly lower mean fasting levels of glucose (-6.5 mg/dL; P = 0.03), insulin (-2.75 μU/mL; P = 0.01), low density lipoprotein cholesterol (-20.0 mg/dL; P < 0.001), C-reactive protein (log-transformed) (-0.42; P = 0.002), homeostasis model assessment-estimated insulin resistance (-0.75; P = 0.02), and higher mean high density lipoprotein cholesterol (+11.4 mg/dL; P < 0.001) compared to matched controls. BarS cases showed lower incidence of diabetes (1.8% vs 11.7%; P = 0.007) and nominally lower MetS (13.7% vs 22.3%; P = 0.23).
Conclusions:
We found no evidence of lasting adverse cardiometabolic health consequences of severe obesity in a sample of cohort participants who underwent a BarS procedure. On average, BarS cases showed features of better cardiometabolic health than postoperative-matched nonsurgical controls who followed a more moderate trajectory of obesity.
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