Metabolic and Bariatric Surgery as a Strategy for Cardiovascular Risk Reduction in Obesity: A Narrative Review

Obesity is a major global healthcare problem and an important contributor to cardiovascular morbidity and mortality through complex metabolic, haemodynamic, inflammatory, and endothelial mechanisms. Excess adiposity promotes the development of hypertension, dyslipidaemia, and type 2 diabetes, as well as cardiac remodelling and heart failure, significantly increasing cardiovascular risk. The aim of this review was to assess the impact of bariatric and metabolic surgery on cardiovascular risk factors and systemic changes associated with the cardiovascular system in patients with obesity. Relevant literature was identified through PubMed/MEDLINE and Google Scholar searches, focusing primarily on studies published between 2020 and 2025, including randomised controlled trials, meta-analyses, epidemiological studies, and clinical investigations. Available evidence indicates that bariatric surgery, particularly sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), induces substantial and sustained weight loss while improving key metabolic parameters. Reported benefits include significant reductions in blood pressure, improvements in glycaemic control and insulin sensitivity, favourable changes in lipid profiles, reduced systemic inflammation and oxidative stress, and improved endothelial function. Observational studies and meta-analyses further suggest that, compared with conservative treatment, bariatric surgery is associated with lower rates of major adverse cardiovascular events (MACEs), coronary artery disease (CAD), heart failure, myocardial infarction (MI), stroke, and all-cause mortality. However, bariatric procedures are associated with potential risks, such as nutritional deficiencies, postoperative hypoglycaemia, weight regain (WR), and procedure-specific complications; therefore, long-term follow-up and multidisciplinary care are required. Overall, bariatric surgery plays an important role in cardiovascular risk reduction in patients with obesity, but further prospective studies are needed to better define the durability of its benefits.