Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Therapy Insight: weight-loss surgery and major cardiovascular risk factors

Abstract

Weight-loss surgery is an effective treatment for severe, medically complicated and refractory obesity. It reverses, eliminates or significantly ameliorates major cardiovascular risk factors related to obesity. In a large proportion of patients, the therapy produces significant weight loss, reduces the risk of disability and premature death, and improves quality of life. Surgical treatment by gastric-restrictive and malabsorptive procedures started several decades ago in the US. Since the 1970s, accrued clinical experience and advances in technology, particularly in minimally invasive surgical approaches, have changed this therapy. Some procedures have evolved, whereas others have become obsolete. Today's weight-loss operations are safe, effective and potentially life-saving options for severely obese cardiology patients. This review describes weight-loss surgery procedures and their effects on cardiovascular risk factors.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Restrictive weight-loss surgery procedures.
Figure 2: Malabsorptive bariatric procedure.

Similar content being viewed by others

References

  1. Sjostrom L et al. (2004) Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351: 2683–2693

    Article  Google Scholar 

  2. Mun EC et al. (2001) Current status of medical and surgical therapy for obesity. Gastroenterology 120: 669–681

    Article  CAS  Google Scholar 

  3. Christou NV et al. (2004) Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 240: 416–423

    Article  Google Scholar 

  4. WHO (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894: 1–253

  5. Haslam DW and James WPT (2005) Obesity. Lancet 366: 1197–1209

    Article  Google Scholar 

  6. Eckel RH et al. (2004) American Heart Association. Prevention Conference VII: Obesity, a worldwide epidemic related to heart disease and stroke: executive summary. Circulation 110: 2968–2975

    Article  Google Scholar 

  7. National Institutes of Health (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Obes Res 6 (Suppl): 51S–209S

  8. Blackburn GL et al. (2004) Evidence-based recommendations for best practices in weight loss surgery. Obes Res 13: 203–204

    Article  Google Scholar 

  9. Buchwald H and Buchwald JN (2002) Evolution of operative procedures for the management of morbid obesity 1950–2000. Obes Surg 12: 705–717

    Article  Google Scholar 

  10. Schroder T et al. (2001) Anesthesia in extreme obesity. Herz 26: 222–228

    Article  CAS  Google Scholar 

  11. Pratt JSA and Blackburn GL (2003) Surgical approaches to the treatment of obesity: a practical guide for the covering physician. In Office Management of Obesity, edn 1, 275–298 (Ed. Bray GA) Philadelphia: Elsevier

    Google Scholar 

  12. Maggard MA et al. (2005) Meta-analysis: surgical treatment of obesity Ann Intern Med 142: 547–559

    Article  Google Scholar 

  13. Cone RD (2005) Anatomy and regulation of the central melanocortin system. Nat Neurosci 8: 571–578

    Article  CAS  Google Scholar 

  14. Park AJ and Bloom SR (2005) Neuroendocrine control of food intake. Curr Opin Gastroenterol 21: 228–233

    Article  CAS  Google Scholar 

  15. Stylopoulos N et al. (2005) Changes in serum ghrelin predict weight loss after Roux-en-Y gastric bypass in rats. Surg Endosc [10.1007/s00464-004-8825-x]

  16. Korner J et al. (2005) Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab 90: 359–365

    Article  CAS  Google Scholar 

  17. Fruhbeck G et al. (2004) Fasting plasma ghrelin concentrations 6 months after gastric bypass are not determined by weight loss or changes in insulinemia. Obes Surg 14: 1208–1215

    Article  Google Scholar 

  18. Meier JJ and Nauck MA (2005) Glucagon-like peptide 1 (GLP-1) in biology and pathology. Diabetes Metab Res Rev 21: 91–117

    Article  CAS  Google Scholar 

  19. Kelly J et al. (2005) Best practice recommendations for surgical care in weight loss surgery. Obes Res 13: 227–233

    Article  Google Scholar 

  20. Klein S et al. (2004) American Heart Association Scientific Statement. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 110: 2952–2967

    Article  Google Scholar 

  21. Buchwald H (2005) Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg 200: 593–604

    Article  Google Scholar 

  22. Nanni G et al. (1997) Biliopancreatic diversion: clinical experience. Obes Surg 7: 26–29

    Article  CAS  Google Scholar 

  23. Marceau P et al. (1999) Biliopancreatic diversion (duodenal switch procedure). Eur J Gastroenterol Hepatol 11: 99–103

    Article  CAS  Google Scholar 

  24. Lehman Center Weight Loss Surgery Expert Panel (2005) Commonwealth of Massachusetts Betsy Lehman Center for Patient Safety and Medical Error Reduction Expert Panel on Weight Loss Surgery: executive report. Obes Res 13: 205–226

  25. Schauer P et al. (2003) The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endos 17: 212–215

    Article  CAS  Google Scholar 

  26. Nguyen NT et al. (2000) A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg 191: 149–155

    Article  CAS  Google Scholar 

  27. Dixon JB and O'Brien PE (1999) Gastroesophageal reflux in obesity: the effect of lap-band placement. Obes Surg 9: 527–531

    Article  CAS  Google Scholar 

  28. Dixon JB et al. (2003) Improvements in insulin sensitivity and β-cell function (HOMA) with weight loss in the severely obese. Diabet Med 20: 127–134

    Article  CAS  Google Scholar 

  29. Dixon JB et al. (2004) Sustained weight loss in obese subjects has benefits that are independent of attained weight. Obes Res 12: 1895–1902

    Article  Google Scholar 

  30. Dixon JB et al. (2005) Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes Relat Metab Disord [10.1038/sj.ijo.0802960]

  31. Dixon JB et al. (2005) Surgery as an effective early intervention for diabesity: Why the reluctance? Diabetes Care 28: 472–474

    Article  Google Scholar 

  32. Dixon AF et al. (2005) Laparoscopic adjustable gastric banding induces prolonged satiety: a randomized blind crossover study. J Clin Endocrinol Metab 90: 813–819

    Article  CAS  Google Scholar 

  33. Hall JE et al. (2002) Mechanisms of obesity-associated cardiovascular and renal disease. Am J Med Sci 324: 127–137

    Article  Google Scholar 

  34. Hackam DG and Anand SS (2003) Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. JAMA 290: 932–940

    Article  Google Scholar 

  35. Eyre H et al. (2004) Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. CA Cancer J Clin 54: 190–207

    Article  Google Scholar 

  36. Droyvold WB et al. (2005) Change in body mass index and its impact on blood pressure: a prospective population study. Int J Obes Relat Metab Disord 29: 650–655

    Article  CAS  Google Scholar 

  37. Tanne D et al. (2005) Body fat distribution and long-term risk of stroke mortality. Stroke 36: 1021–1025

    Article  Google Scholar 

  38. Gavrila A et al. (2003) Serum adiponectin levels are inversely associated with overall and central fat distribution but are not directly regulated by acute fasting or leptin administration in humans: cross-sectional and interventional studies. J Clin Endocrinol Metab 88: 4823–4831

    Article  CAS  Google Scholar 

  39. Sjöstrom CD et al. (1999) Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res 7: 477–484

    Article  Google Scholar 

  40. Blackburn GL (2005) Solutions in weight control: lessons from gastric surgery. Am J Clin Nutr 82 (Suppl 1): 248S–252S

    Article  CAS  Google Scholar 

  41. Danias PG et al. Cardiac structure and function in the obese: a cardiovascular magnetic resonance imaging study. J Cardiovasc Magn Reson 5: 431–438

  42. Friberg P et al. (2004) Increased left ventricular mass in obese adolescents. Eur Heart J 25: 987–992

    Article  CAS  Google Scholar 

  43. Danias PG et al. (2003) Comparison of aortic elasticity determined by cardiovascular magnetic resonance imaging in obese versus lean adults. Am J Cardiol 91: 195–199

    Article  Google Scholar 

  44. Karason K et al. (1998) Effects of obesity and weight loss on cardiac function and valvular performance. Obes Res 6: 422–429

    Article  CAS  Google Scholar 

  45. Alpert MA et al. (2001) Effect of weight loss on the ECG of normotensive morbidly obese patients. Chest 119: 507–510

    Article  CAS  Google Scholar 

  46. Saltzman E et al. (2005) Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient. Obes Res 13: 234–243

    Article  Google Scholar 

  47. Eilat-Adar S et al. (2005) Association of intentional changes in body weight with coronary heart disease event rates in overweight subjects who have an additional coronary risk factor. Am J Epidemiol 161: 352–358

    Article  Google Scholar 

  48. Pories WJ et al. (1992) Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr 55 (Suppl 2): 582S–585S

    Article  CAS  Google Scholar 

  49. Choban PS (2002) Bariatric surgery for morbid obesity: why, who, when, how, where, and then what? Cleve Clin J Med 69: 897–903

    Article  Google Scholar 

  50. Buchwald H et al. (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292: 1724–1737

    Article  CAS  Google Scholar 

  51. Kopp HP et al. (2003) Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscler Thromb Vasc Biol 23: 1042–1047

    Article  CAS  Google Scholar 

  52. Pontiroli AE et al. (2004) Left ventricular hypertrophy and QT interval in obesity and in hypertension: effects of weight loss and of normalisation of blood pressure. Int J Obes Relat Metab Disord 28: 1118–1123

    Article  CAS  Google Scholar 

  53. ACP Observer (online April 2005) New ACP guidelines target obesity management. American College of Physicians [http://www.acponline.org/journals/news/apr05/obesity.htm#care] (accessed 2 August 2005)

  54. Chapman AE et al. (2004) Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 135: 326–351

    Article  Google Scholar 

  55. Fernandez AZ Jr et al. (2004) Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc 18: 193–197

    Article  Google Scholar 

  56. Sugerman HJ et al. (2001) Risks and benefits of gastric bypass in morbidly obese patients with severe venous stasis disease. Ann Surg 234: 41–46

    Article  CAS  Google Scholar 

  57. Flum DR and Dellinger EP (2004) Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg 199: 543–551

    Article  Google Scholar 

  58. Chapman AE et al. (2004) Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 135: 326–351

    Article  Google Scholar 

  59. Fielding GA and Ren CJ (2005) Laparoscopic adjustable gastric band. Surg Clin North Am 85: 129–140

    Article  Google Scholar 

  60. Pratt JS et al. (2004) Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 25-2004. A 49-year-old woman with severe obesity, diabetes, and hypertension. N Engl J Med 35: 696–705

    Article  Google Scholar 

Download references

Acknowledgements

We thank Rita Buckley for medical writing and editing services.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George L Blackburn.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Blackburn, G., Mun, E. Therapy Insight: weight-loss surgery and major cardiovascular risk factors. Nat Rev Cardiol 2, 585–591 (2005). https://doi.org/10.1038/ncpcardio0349

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio0349

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing