Change in predicted 10-year and lifetime cardiovascular disease risk after Roux-en-Y gastric bypass

Cardiovascular disease risk scores in patients with optimal vs suboptimal weight loss after bariatric surgery: Translating improvements into clinical practice

INTRODUCTION

The aim of this study was to evaluate cardiovascular disease (CVD) risk modification in patients with optimal weight loss (OWL) versus suboptimal weight loss SWL following MBS.

METHODS

This was a retrospective analysis. The 10-year risk CVD was estimated before and after one year of surgery using the "Framingham Score".

RESULTS

191 patients were included in our study. Mean baseline Framingham score was 7.2 ​± ​6.9%. According to the score, 54% of patients were classified as low risk (n ​= ​104), 23% as moderate (n ​= ​43), 20% moderately high (n ​= ​39) and 3% as high risk (n ​= ​5). One year after surgery, 91% of the patients showed reduction of their Framingham score. Mean CVD risk score decreased significantly to 4.1 ​± ​3.7% when compared to baseline (p-value is ​< ​0.001); 80% of patients classified as low risk (n ​= ​153), 13% as moderate (n ​= ​25), 7% moderately high (n ​= ​13) and 0% as high risk (n ​= ​0).

CONCLUSION

Weight loss after bariatric surgery reduces CVD risk scores and the magnitude of effect correlates with the degree of weight loss.

Changes in physical function and physical activity in patients up to 5 years after bariatric surgery

BACKGROUND

Bariatric surgery is effective for patients with severe obesity, but relatively little is known about long-term functional outcomes.

OBJECTIVE

To describe physical fitness and activity changes among bariatric surgery patients in a clinical trial of physical activity interventions through 5 years postoperatively.

SETTING

Large bariatric center in the midwestern United States.

METHODS

Preoperatively, 6 months, and 5 years after surgery, 42 bariatric surgery patients wore an accelerometer to track activity and completed strength and cardiovascular endurance testing via treadmill, where estimated metabolic equivalents (METs) and ratings of perceived exertion (RPEs) were obtained.

RESULTS

Preoperatively, 25% of patients reported exertion of <3 METs (equivalent to walking 2.5 mi/hr) as an RPE of 16 ("hard to very hard"). This decreased significantly to approximately 5% of patients 6 months and 5 years after surgery. Before surgery, 7.5% achieved ≥6 METs (vigorous activity) at an RPE of 16. This increased significantly to 36.6% at 6 months and 42.1% at 5 years after surgery. Body mass index and age, but no physical activity measure, predicted functional ability over time. The steps/d and exercise bout min/wk increased significantly from before surgery to 6 months postoperatively (4886.5 to 5948.5 steps and 23.8 to 66.6 bout min), but increases were not maintained at 5 years (5677.7 steps and 41.4 bout min). Conversely, moderate to vigorous min/ d increased progressively from before surgery (17.4) to 6 months (32.3) and 5 years (48.1) postoperatively.

CONCLUSIONS

Functional abilities of bariatric surgery patients increased postoperatively and were maintained over 5 years. However, treadmill testing suggests that most patients are still unable to perform sustained activities of 6 METs (vigorous) or greater. Research is needed on bariatric patients' long-term function- and intervention- optimizing outcomes.

An Assessment of the Effect of Bariatric Surgery on Cardiovascular Disease Risk in the Chinese Population Using Multiple Cardiovascular Risk Models

BACKGROUND

Many studies have reported that bariatric surgery may reduce postoperative cardiovascular risk in patient with obesity, but few have addressed this risk in the Chinese population.

OBJECTIVE

To assess the impact of bariatric surgery on cardiovascular disease (CVD) risk in the Chinese population using the World Health Organization (WHO) risk model, the Global risk model, and the Framingham Risk Score.

METHODS

We retrospectively analyzed data collected on patient with obesity who underwent bariatric surgery at our institution between March 2009 and January 2021. Their demographic characteristics, anthropometric variables, and glucolipid metabolic parameters were assessed preoperatively and at their 1-year postoperative follow-up. Subgroup analysis compared body mass index (BMI) < 35 kg/m² and BMI ≥ 35 kg/m², as well as gender. We used the 3 models to calculate their CVD risk.

RESULTS

We evaluated 61 patients, of whom 26 (42.62%) had undergone sleeve gastrectomy (SG) surgery and 35 (57.38%) Roux-en-Y gastric bypass (RYGB) surgery. Of the patients with BMI ≥ 35 kg/m², 66.67% underwent SG, while 72.97% with BMI < 35 kg/m² underwent RYGB. HDL levels were significantly higher at 12 months postoperatively relative to baseline. When the models were applied to calculate CVD risk in Chinese patients with obesity, the 1-year CVD risk after surgery were reduced lot compared with the preoperative period.

CONCLUSION

Patient with obesity had significantly lower CVD risks after bariatric surgery. This study also demonstrates that the models are reliable clinical tools for assessing the impact of bariatric surgery on CVD risk in the Chinese population.

Differential effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) and fatty acids

BACKGROUND

Limited evidence suggests that surgical and non-surgical obesity treatment differentially influence plasma Lipoprotein (a) [Lp(a)] levels. Further, a novel association between plasma arachidonic acid and Lp(a) has recently been shown, suggesting that fatty acids are a possible target to influence Lp(a). Here, the effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) were compared, and it was examined whether the effects were mediated by changes in plasma fatty acid (FA) levels.

METHODS

The study includes two independent trials of patients with overweight or obesity. Trial 1: Two-armed intervention study including 82 patients who underwent a 7-week low energy diet (LED), followed by Roux-en-Y gastric bypass and 52-week follow-up (surgery-group), and 77 patients who underwent a 59-week energy restricted diet- and exercise-program (lifestyle-group). Trial 2: A clinical study including 134 patients who underwent a 20-week very-LED/LED (lifestyle-cohort).

RESULTS

In the surgery-group, Lp(a) levels [median (interquartile range)] tended to increase in the pre-surgical LED-phase [17(7-68)-21(7-81)nmol/L, P = 0.05], but decreased by 48% after surgery [21(7-81)-11(7-56)nmol/L, P < 0.001]. In the lifestyle-group and lifestyle-cohort, Lp(a) increased by 36%[14(7-77)-19(7-94)nmol/L, P < 0.001] and 14%[50(14-160)-57(19-208)nmol/L, P < 0.001], respectively. Changes in Lp(a) were independent of weight loss. Plasma levels of total saturated FAs remained unchanged after surgery, but decreased after lifestyle interventions. Arachidonic acid and total n-3 FAs decreased after surgery, but increased after lifestyle interventions. Plasma FAs did not mediate the effects on Lp(a).

CONCLUSION

Bariatric surgery reduced, whereas lifestyle interventions increased plasma Lp(a), independent of weight loss. The interventions differentially influenced changes in plasma FAs, but these changes did not mediate changes in Lp(a).

TRIAL REGISTRATION

Trial 1: Clinicaltrials.gov NCT00626964. Trial 2: Netherlands Trial Register NL2140 (NTR2264).

A 7-Year Study of the Durability of Improvements in Pain, Physical Function, and Work Productivity After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

IMPORTANCE

Bariatric surgical procedures are associated with clinically important improvements (CIIs) in pain and physical function. However, there are declines in initial improvement by the third postoperative year, and the long-term durability of improvements are not well-described.

OBJECTIVE

To evaluate the durability of improvements in pain and physical function through 7 years after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

DESIGN, SETTING, AND PARTICIPANTS

This study is part of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a cohort study at 10 US hospitals. Adults with severe obesity (ie, body mass index of 35 or greater) undergoing bariatric surgery were assessed preoperatively (2006-2009) and followed up annually for as long as 7 years or until 2015. Of 1829 participants who underwent RYGB or SG in LABS-2, 338 were excluded from this study because they had a follow-up period of less than 5 years. Analysis of participants who underwent RYGB or SG and completed research assessments preoperatively and postoperatively for 5 to 7 years was conducted from March to April 2022.

MAIN OUTCOMES AND MEASURES

Preoperative-to-postoperative CIIs in pain and physical function scores from the 36-Item Short Form Health Survey and the Western Ontario McMaster Osteoarthritis Index, and 400-meter walk time, using previously established thresholds; and remission of mobility deficit, ie, inability to walk 400 meters in 7 minutes or less.

RESULTS

A total of 1491 individuals were included, with 1194 (80%) women; 59 (4%) Hispanic, 164 (11%) non-Hispanic Black, and 1205 (82%) non-Hispanic White individuals; a preoperative median (IQR) age of 47 (38-55) years; and a preoperative median (IQR) body mass index of 47 (42-52). Between 3 and 7 years after surgery, the percentage of participants with preoperative-to-postoperative CIIs in bodily pain decreased from 50% (95% CI, 48%-53%) to 43% (95% CI, 40%-46%), in physical function from 75% (95% CI, 73%-77%) to 64% (95% CI, 61%-68%), and in 400-meter walk time from 61% (95% CI, 56%-65%) to 50% (95% CI, 45%-55%). Among participants with a preoperative mobility deficit, remission decreased from 50% (95% CI, 42%-57%) to 41% (95% CI, 32%-49%), and among participants with severe knee or hip pain or disability, the percentage with CIIs in knee and hip pain and function decreased (eg, hip pain: from 77% [95% CI, 72%-82%] to 65% [95% CI, 58%-72%]; knee function: from 77% [95% CI, 73%-82%] to 72% [95% CI, 67%-77%]).

CONCLUSIONS AND RELEVANCE

In this cohort study, despite decreases in preoperative-to-postoperative improvements across follow-up, CIIs in perceived bodily and joint-specific pain and in self-reported and objectively measured physical function ranged from 41% to 72%, depending on the measure and subgroup, 7 years after surgery, suggesting that RYGB and SG are commonly associated with long-term CIIs in pain and physical function.

Glycemic Patterns Are Distinct in Post-Bariatric Hypoglycemia After Gastric Bypass (PBH-RYGB)

CONTEXT

Severe hypoglycemia with neuroglycopenia, termed post-bariatric hypoglycemia (PBH). typically occurs postprandially, but it is also reported after activity or mid-nocturnally.

OBJECTIVE

To quantify glycemia, glycemic variability, and magnitude/duration of low sensor glucose (SG) values in patients with PBH after Roux-en-Y gastric bypass (PBH-RYGB).

METHODS

This retrospective analysis of data from an academic medical center included individuals with PBH-RYGB (n = 40), reactive hypoglycemia without gastrointestinal surgery (Non-Surg Hypo, n = 20), prediabetes (Pre-DM, n = 14), newly diagnosed T2D (n = 5), and healthy controls (HC, n = 38). Masked continuous glucose monitoring (Dexcom G4) was used to assess patterns over 24 hours, daytime (6 am-midnight) and nighttime (midnight-6 am). Prespecified measures included mean and median SG, variability, and percent time at thresholds of sensor glucose.

RESULTS

Mean and median SG were similar for PBH-RYGB and HC (mean: 99.8 ± 18.6 vs 96.9 ± 10.2 mg/dL; median: 93.0 ± 14.8 vs 94.5 ± 7.4 mg/dL). PBH-RYGB had a higher coefficient of variation (27.3 ± 6.8 vs 17.9 ± 2.4%, P < 0.0001) and range (154.5 ± 50.4 vs 112.0 ± 26.7 mg/dL, P < 0.0001). Nadir was lowest in PBH-RYGB (42.5 ± 3.7 vs HC 49.0 ± 11.9 mg/dL, P = 0.0046), with >2-fold greater time with SG < 70 mg/dL vs HC (7.7 ± 8.4 vs 3.2 ± 4.1%, P = 0.0013); these differences were greater at night (12.6 ± 16.9 vs 1.0 ± 1.5%, P < 0.0001). Non-Surg Hypo also had 4-fold greater time with SG < 70 at night vs HC (SG < 70: 4.0 ± 5.9% vs 1.0 ± 1.5%), but glycemic variability was not increased.

CONCLUSION

Patients with PBH-RYGB experience higher glycemic variability and frequency of SG < 70 compared to HC, especially at night. These data suggest that additional pathophysiologic mechanisms beyond prandial changes contribute to PBH.

Predictors of change in cardiovascular disease risk and events following gastric bypass: a 7-year prospective multicenter study

BACKGROUND

Change in short-term (i.e., 10-year) and lifetime risk of cardiovascular disease (CVD) following Roux-en-Y gastric bypass (RYGB) has significant heterogeneity.

OBJECTIVE

To identify predictors of change in CVD risk and cardiovascular events following RYGB.

METHODS

Between 2006-2009, 1625 adults without a history of CVD enrolled in a prospective cohort study and underwent RYGB at 1 of 10 U.S. hospitals. Participants were followed annually for a maximum of 7 years. Associations between presurgery characteristics (anthropometric, sociodemographic, physical and mental health, alcohol/drug use, eating behaviors) and 1) pre to postsurgery change in 10 year and lifetime atherosclerotic CVD (ASCVD) risk scores, respectively, and 2) having a CVD event (nonfatal myocardial infarction, stroke, ischemic heart disease, congestive heart failure, angina, percutaneous coronary intervention, coronary artery bypass grafting, or CVD-attributed death) as repeated measures (yr 1-7) were evaluated.

SETTING

Observational cohort study at ten hospitals throughout the United States.

RESULTS

Presurgery factors independently associated with decreases in both 10-year and lifetime risk scores 1-7 years post-RYGB were higher CVD risk score, female sex, higher household income, and normal kidney function. Additionally, Black race and having diabetes were independently associated with decreases in 10-year risk, while not having diabetes and a higher (better) composite mental health score were independently related to decreases in lifetime risk. A lower (worse) presurgery composite physical health score was associated with a higher CVD event risk (RR = 1.68, per 10 points).

CONCLUSION

This study identified multiple presurgery factors that characterize patients who may have more cardiovascular benefit from RYGB, and patients who might require additional support to improve their cardiovascular health.

Impact of metabolic surgery on 10-year cardiovascular disease risk in Chinese individuals with type 2 diabetes

BACKGROUND

In recent years, many reports have highlighted that metabolic surgery may ameliorate the cardiovascular risk in morbidly obese patients with or without type 2 diabetes (T2D). However, few studies have evaluated the long-term cardiovascular disease (CVD) risk after metabolic surgery in T2D patients with a low body mass index (BMI).

OBJECTIVES

To use the Prediction for ASCVD Risk in China (China-PAR) equations and United Kingdom Prospective Diabetes Study (UKPDS) risk engine to assess the 10-year CVD risk in low-BMI T2D patients after metabolic surgery.

SETTING

University hospital, China.

METHODS

We retrospectively reviewed our prospectively collected data of T2D patients who underwent metabolic surgery at our hospital between 2010 and 2018. We included patients who met the criteria for calculating a 10-year cardiovascular risk score by the China-PAR equations and UKPDS risk engine. Demographic characteristics, anthropometric variables, and glycolipid metabolic parameters were assessed preoperatively and during a 4-year follow-up period. Patients with a BMI < 30 kg/m² were compared with those with a BMI > 30 kg/m².

RESULTS

We evaluated 117 patients, of whom 62 (53%) had a BMI < 30 kg/m² and 55 (47%) had a BMI > 30 kg/m². Patients with a BMI < 30 kg/m² were significantly older and had a longer duration of diabetes. The rate of complete T2D remission in the group of patients with BMIs < 30 kg/m² was significantly lower than that in the group with BMIs > 30 kg/m² (35.2% versus 56.1%, respectively; P = .042). The overall 10-year and lifetime atherosclerotic cardiovascular disease risks were reduced from 4.2% to 2.3% and 25.3% to 13.9%, respectively (both P < .05), at 1 year postoperatively using the China-PAR equation. The overall 10-year coronary heart disease (CHD) and fatal CHD risks were reduced by 48.1% and 53.1%, respectively, at 1 year after surgery using the UKPDS risk engine. The advantages of metabolic surgery in reducing CVD risks are similar in both BMI groups, whether using the China-PAR equation or the UKPDS risk engine.

CONCLUSION

The 10-year CVD risk in T2D patients with BMIs < 30 kg/m² and BMIs > 30 kg/m² were significantly reduced after metabolic surgery, although the rate of complete T2D remission T2Din patients with BMIs < 30 kg/m² was lower than that in patients with BMIs > 30 kg/m². The China-PAR equation is a reliable and useful clinical tool for CVD risk evaluation in Chinese patients after metabolic surgery.