Preventive cardiology
Reduction in Predicted Coronary Heart Disease Risk After Substantial Weight Reduction After Bariatric Surgery

https://doi.org/10.1016/j.amjcard.2006.08.017Get rights and content

In recent years, bariatric surgery has become an increasingly used therapeutic option for morbid obesity. The effect of weight loss after bariatric surgery on the predicted risk of coronary heart disease (CHD) has not previously been studied. We evaluated baseline (preoperative) and follow-up (postoperative) body mass index, CHD risk factors, and Framingham risk scores (FRSs) for 109 consecutive patients with morbid obesity who lost weight after laparoscopic Roux-en-Y gastric bypass surgery. Charts were abstracted using a case-report form by a reviewer blinded to the FRS results. The study included 82 women (75%) and 27 men (25%) (mean age 46 ± 10 years). Mean body mass index values at baseline and follow-up were 49 ± 8 and 36 ± 8 kg/m2, respectively (p <0.0001). During an average follow-up of 17 months, diabetes, hypertension, and dyslipidemia resolved or improved after weight loss. Thus, the risks of CHD as predicted by FRS decreased by 39% in men and 25% in women. The predicted 10-year CHD risks at baseline and follow-up were 6 ± 5% and 4 ± 3%, respectively (p ≤0.0001). For those without CHD, men compared favorably with the age-matched general population, with a final 10-year risk of 5 ± 4% versus an expected risk of 11 ± 6% (p <0.0001). Likewise, women achieved a level below the age-adjusted expected 10-year risk of the general population, with a final risk of 3 ± 3% versus 6 ± 4% (p <0.0001). In conclusion, weight loss results in a significant decrease in FRS 10-year predicted CHD risk. Bariatric surgery decreases CHD risk to rates lower than the age- and gender-adjusted estimates for the general population. These data suggest substantial and sustained weight loss after bariatric surgery may be a powerful intervention to decrease future rates of myocardial infarction and death in the morbidly obese.

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Methods

The study sample included 109 consecutive, morbidly obese patients who were evaluated at the William Beaumont Hospital Weight Control Center (Royal Oak, Michigan) from November 2001 to December 2003, and underwent laparoscopic Roux-en-Y gastric bypass surgery. Because the study was a retrospective chart review, it was considered exempt from the hospital’s human investigations committee review.

All patients underwent a comprehensive medical evaluation with a complete history and physical

Results

The study population was a mean age of 47 ± 10 years with 82 women (75%) and 27 men (25%; Table 1). Of 109 patients, 96 were Caucasian (88%), 9 were African-American (8%), and 4 were of another race (4%). Baseline diabetes mellitus was noted in 25 of 82 men (31%) and 15 of 27 women (56%, p = 0.02). Overall, baseline hypertension was present in 20 of 27 men (74%) and 44 of 82 women (54%, p = 0.06). Mean preoperative BMI for all patients was 49 ± 8 kg/m2 (range 37 to 90). Average baseline BMI

Discussion

Our study is the first to quantify a global decrease in CHD risk after substantial and sustained weight loss secondary to bariatric surgery. We found that weight loss was effective in decreasing the FRS 10-year predicted CHD risk in men and women; however, the decrease in CHD risk was greater in men. Moreover, men and women without CAD achieved a lower CHD risk compared with the gender-specific population of a comparable age.17 Accordingly, this is the first study to suggest that a surgical

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