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Metabolic surgery results in cardiometabolic improvements in people with severe obesity

Patients who underwent metabolic surgery had significant improvements in cardiometabolic health, according to researchers from Vanderbilt University Medical Center in Nashville, TN. Specifically, patient of a younger age group, women, white patients and those without comorbidities generally showed greater cardiometabolic improvements than older patients, men, black patients, and those with existing cardiometabolic disease(s).

"Our study highlights how bariatric surgery not only leads to significant weight loss but also substantially improves heart health," said study author, Lei Wang from Vanderbilt University Medical Center. "These health benefits include lower blood pressure, blood lipids and blood sugar, and an estimated 35% reduction in 10-year cardiovascular disease risk one year after surgery."

The researchers analysed 7,804 people between the ages of 20 to 79 who underwent bariatric surgery during 1999–2022 at the Vanderbilt University Medical Center. Most study participants were women and white, but the study also includes a significant number of male patients and Black patients, who have been underrepresented in bariatric surgery research.

The researchers evaluated various cardiometabolic improvements, including blood pressure, cholesterol, glucose and HbA1c. They also measured remission rates of diabetes, hypertension and dyslipidaemia, and the estimated ten-year cardiovascular disease risk.

Among 7,804 patients, most were women and White, while 1,618 were men and 1,271 were Black; median age and BMI were 45 years and 46.4kg/m2. At one-year post-surgery, patients showed significant decreases in systolic blood pressure (10.5 [95% confidence interval: 10.1, 10.9] mmHg), total cholesterol (13.5 [10.3, 16.7] mg/dL), glucose (13.6 [12.9, 14.4] mg/dL), haemoglobin A1c (1.13% [1.06, 1.20]), and 10-year ASCVD risk (absolute reduction: 1.58% [1.22, 1.94]; relative reduction: 34.4% [29.4, 39.3]) (all p<0.0001).

Older, male, or Black patients showed less reduction in ten-year ASCVD risk and lower odds of diabetes/hypertension/dyslipidaemia remission than younger, female or white patients. Patients with a history of diabetes, hypertension, dyslipidaemia or cardiovascular disease showed less cardiometabolic improvements than those without. Results were similar with or without further adjusting for weight loss and largely sustained at two-years post-surgery.

“Additionally, 30% to 50% of people in our study experienced remissions of diabetes, hypertension and dyslipidemia," added co-author, Dr Danxia Yu also from Vanderbilt University Medical Center. "Individuals who were younger, female, self-identified as white and had no history of cardiometabolic diseases tended to see greater post-surgery cardiometabolic improvements."

"Our findings can help people with severe obesity experience better health outcomes and help us recognize which patients may require extra health management after surgery," Wang concluded.

The findings were reported in the paper, ‘Cardiometabolic Improvements After Metabolic Surgery and Related Pre-surgery Factors’, published in the Journal of the Endocrine Society.

To access this paper, please click here


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