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Risk factors

Variety of factors impact on effectiveness of surgery

Non-Hispanic black and Hispanic patients were less likely than non-Hispanic white patients to experience metabolic syndrome remission

The impact of bariatric surgery on risk factors for cardiovascular disease depends on a variety of factors, including the type of surgery, sex of the patient, ethnic background, and pre-surgery body mass index, according to a Kaiser Permanente study published in Annals of Surgery.

Researchers examined the electronic health records of more than 4,000 Kaiser Permanente patients in Southern California who had bariatric surgery for weight loss between 2009 and 2011 to determine what factors led to remission or reduction of metabolic syndrome after surgery. Patients were studied for up to two years after their bariatric surgery to determine if their metabolic syndrome improved.

The researchers report that non-Hispanic black and Hispanic patients were less likely than non-Hispanic white patients to experience metabolic syndrome remission. These differences in remission were not a result of greater weight loss during the follow-up period, and these racial and ethnic differences persisted even when researchers controlled for the rate of weight loss.

"In the majority of patients, bariatric surgery may result in the remission of many cardiovascular disease risk factors, which could prevent those patients from experiencing more serious health conditions, such as heart attack and stroke," said study lead author, Dr Karen J Coleman of the Kaiser Permanente Department of Research & Evaluation in Pasadena, CA. "The benefits of bariatric surgery are different for men and women and different racial/ethnic groups. This study highlights the importance of designing post-operative care models to address the unique challenges different genders and ethnic/racial groups face following bariatric surgery."

Karen J Coleman

The paper also reports that researchers also found women were more likely than men to experience remission and patients who were heavier at the time of their surgery were less likely to experience remission than those who were lighter.

However, the effects of age, race/ethnicity, and BMI at the time of surgery remained after accounting for weight loss.

Interestingly, patients who received the gastric sleeve were less likely to experience metabolic syndrome remission than patients who had a traditional gastric bypass.

Some individual markers of cardiovascular health were more likely to improve than others following bariatric surgery. For example, 44 percent lost enough weight following surgery to no longer be considered obese, and a significant 85 percent of patients' blood pressure returned to healthy levels.

The study included patients who had a laparoscopic Roux-en-Y gastric bypass or a laparoscopic vertical sleeve gastrectomy between 2007 and 2009 (n=4088) without revision during the study period of January  2007 tand December 2011. Diagnosis and resolution of metabolic syndrome were determined using standard criteria with electronic medical records of laboratory, diagnosis, and pharmacy information.

Nearly half (49 percent) of the Kaiser Permanente study's sample were either Hispanic or non-Hispanic black, providing a unique opportunity to study the effect of bariatric surgery on metabolic syndrome in different racial/ethnic groups.

Conclusion

"Although we do not know the reasons for the racial and ethnic differences we saw, one explanation could be that the black and Hispanic patients had surgery when they are much heavier and sicker than the non-Hispanic white patients," said Coleman "Our study highlights that surgery may be an important intervention tool for people earlier in their weight gain trajectory. The heavier they become, the less likely that surgery will be successful at reducing these cardiovascular disease risk factors."

Based on the findings they conclude that bariatric surgery may be most effective for patients who are younger and early in the course of their cardiometabolic disease. Future research should investigate the factors that lead to lower rates of disease resolution after bariatric surgery for racial/ethnic minority groups.

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