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Studies show durability of bariatric surgery procedures

Dr John Morton presented the first study.
Bypass demonstrates the most significant improvements in cardiovascular risk factors
Resolution of metabolic syndrome evident five years post-surgery

Two studies presented at the recent American College of Cardiology 2013 Scientific Sessions meeting in San Francisco, have reported that bariatric surgical procedures result in a significant reduction in cardiovascular risk factors, with laparoscopic gastric banding proving durable at resolving metabolic syndrome to five years post-surgery.

The first presentation, ‘Comparative effectiveness for bariatric surgery: cardiac risk factor reduction’, by Dr John Morton, of the Stanford University School of Medicine, Stanford, showed that gastric bypass, banding and sleeve gastrectomy leading to reductions in cardiovascular risk factors, gastric bypass was the only procedure to significantly improve every studied risk factor. Bypass also achieved the lowest average BMI at one year, despite the recipients being of higher average BMI pre-operatively and presenting with a greater number of comorbidities.

At twelve months the follow-up rate was 77.1% and the results showed that the majority of risk factors varied significantly among surgery types. This was particularly evident in fasting insulin, which revealed a 67.0% improvement for gastric bypass patients, 32.6% for band patients, and 63.7% for sleeve patients. C-reactive protein showed 67.1% improvement for gastric bypass, 21.2% for band, and 26.3% for sleeve. Furthermore, the ratio of triglycerides to HDL, a predictor of metabolic syndrome, was differentially improved among surgery types with 38.5% in gastric bypass, 20.6% in band, and 35.2% in sleeve.

Patients who had a gastric bypass also achieved significantly greater excess weight loss (75.1%) compared to both band (42.1%) and sleeve (55.7%).

To assess the comparative effectiveness of gastric bypass, banding and sleeve gastrectomy as related to cardiac risk reduction, Morton and his colleagues prospectively collected pre-operative and twelve-month data for 1,398 consecutive surgeries (1,152 bypasses, 132 bands and 114 sleeve gastrectomies).

Cardiac risk factors were obtained at baseline and twelve months after surgery and all statin use was discontinued after the procedure. The cardiac risk factors collected included:

  • BMI
  • waist circumference
  • hypertension
  • Framingham Risk Score
  • haemoglobin A1C
  • fasting insulin
  • HDL cholesterol
  • LDL cholesterol
  • total cholesterol
  • triglycerides
  • high sensitivity C-reactive protein
  • homocysteine and;
  • lipoprotein(a)

The study was co-authored by Drs Chris Crowe, Natalia Leva, and Trit Garg also from Stanford University School of Medicine.

Gastric banding and metabolic syndrome

A second presentation ‘Gastric banding resolves metabolic syndrome in obese subjects over five years of follow-up’, by Dr Sean Heffron, New York University, revealed that laparoscopic gastric banding produces significant weight loss, resolution of metabolic syndrome and reduced usage of hyperglycemic and anti-hypertensive agents five years after surgery.

The small study included 50 patients with a BMI between 30 and 40 who underwent laparoscopic gastric banding procedure. The primary outcome was diagnosis of metabolic syndrome with the secondary outcomes including individual components of the metabolic syndrome and proportions of patients using oral hyperglycaemic or anti-hypertensive agents.

At baseline, 43% of patients met NCEP ATPIII criteria for metabolic syndrome, which was reduced to 15% at one year and remained decreased throughout five years of follow-up (Figure 1).

Figure 1: precentage of patients meeting NCP ATPIII criteria for diagnosis of metabolic syndrome

"Whether that will translate into prevention of outcomes down the road, we can't say with these data, but it does seem that the procedure resolves metabolic syndrome in those who have it at baseline, and it prevents the appearance of it in those who don't have it at baseline,” Heffron told Medscape News.

The patients also showed mean weight loss of 22.3 ± (22.9 ± 7.4%) at one year and maintained this weight loss (19.8 ± 10.2%, 0<0.001) through five years of follow-up (mean weight 27.9kg; p=0.003).

There were also reductions in the proportion of patients taking oral hyperglycaemic (seven vs four) or anti-hypertensive agents (nine vs six) throughout the five years of the study (p<0.001, p=0.05).

In addition, Heffron reported significant improvements in total cholesterol, LDL cholesterol, triglycerides, and HDL cholesterol for the first two years with fasting blood glucose significantly reduced and sustained for the period of the study.

This study was sponsored by Allergan.

The study was co-authored by Drs Amita Singh, Johnathan Zagzag, Heekoung A Youn, James Underberg, George A Fielding and Christine J Ren, also from New York University.

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