You are here
Surgery has sustained improvement in cardio risk
Bariatric surgery can result in a significant reduction in a patient’s ten year cardiovascular risk, according to two studies presented at this year’s Annual Scientific Meeting of the British Obesity and Metabolic Surgery Society in Leamington Spa, UK, from 22–24 January.
“Although bariatric surgery is the only evidence-based method of long-term weight control in obese individuals, the reduction in individual cardiovascular risk following bariatric surgery has not yet been quantified,” said presenter Dr Rami Radwan from the Institute of Metabolic and Obesity Surgery, Swansea, UK. “QRISK2 is a UK designed, validated and widely used algorithm to predict cardiovascular risk over a ten year period. In this study we calculated the QRISK 2 scores for patients’ pre- and post-bariatric surgery at our institute in an effort to objectively assess cardiovascular risk reduction following bariatric surgery.”
They reviewed all patients who had undergone bariatric surgery over a ten year period (June 2003 – June 2013) at their institute using the Welsh Institute of Metabolic & Obesity Surgery (WIMOS) database. All demographic and cardiovascular risk data was obtained and QRISK2 score was calculated pre- and post-operatively for all patients. Post-operative score was calculated at the point of longest available follow up duration.
A total of 250 patients were included in our cohort; 184 female, median age 36 years (range 24-59 years). Median follow-up post-operatively for all patients was 24 months (mean 34 months, range 1-109 months).
The majority of patients (n=100; 70 female) underwent a sleeve gastrectomy, 67 (26.8%; 45 female) patients had biliary-pancreatic diversion (BPD), 50 (20%; 39 female) patients had a roux-en-y gastric bypass (RYG), and 33 (13.2%; 30 female) were fitted with gastric bands.
Overall median pre-operative ten-year QRISK2 score was 5.6% (mean 9.4%, range 0.3%-45%) and the median postoperative ten-year QRISK2 score in these patients was lower at 4.4% (mean 7.2%, range 0.2%-36.1%); p<0.001.
“This study is the first to use a validated scoring system to assess ten year cardiovascular risk reduction in bariatric patients,” he concluded. “We have demonstrated a significant reduction in cardiovascular risk following bariatric surgery. “
Co-authors of the study were Hazem Al-Momani, Scott Caplin and Jonathan Barry Welsh
A second study from researchers at North Tyneside General Hospital and James Cook University Hospital, Tyne and Wear, UK, assessed whether cardiovascular risk improved in bariatric patients following gastric bypass and if this improvement was sustained.
They analysed cardiovascular risk in 100 bariatric patients undergoing gastric bypass using a validated scoring system (QRISK II) to study their ten-year cardiovascular risk. Only patients who had at least two years follow-up were included. Paired t-test was used to assess if there was statistically significant difference in the QRISK. A total of 100 patients (M:F=1:6) with a mean age of 45.6 years (24-64 years), were included in they study.
The researchers reported that there was a statistically significant fall in the QRISK II score from baseline (6.328±6.75) at one year (3.62±3.45, p<0.0005), which persisted at two years as well (3.79 ± 3.58) (p<0.002).
This was more pronounced in patients with resolution/ remission of comorbidities like diabetes and hypertension. Patients who had long standing diabetes and whose diabetes persisted despite gastric bypass had less significant improvement in QRISK II score. Weight loss was significantly related to reduction in QRISK II.
“Patients undergoing gastric bypass have significant sustained reduction in their ten-year cardiovascular risk,” they concluded. “This is most pronounced in patients who had resolution of metabolic syndrome. We propose early referral to bariatric surgery to improve long-term cardiovascular morbidity.”