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Cardiovascular effects of bariatric surgery

Key Points

  • Obesity is a major risk factor for cardiovascular disease, and is associated with other cardiovascular risk factors such as hypertension, dyslipidaemia, inflammation, and type 2 diabetes mellitus (T2DM)

  • Effective and sustained BMI reduction has consistently been demonstrated in weight-loss programmes that incorporate bariatric surgery

  • Cardiovascular risk factors, such as hypertension, dyslipidaemia, inflammation, ischaemic heart disease, and T2DM have been shown to improve after bariatric surgery, and such benefits are often sustained in the long term

  • Bariatric surgery is associated with a reduction in cardiovascular events, such as myocardial infarction and stroke

Abstract

Obesity is a major global health problem, and its multisystem effects are inextricably linked with elevated cardiovascular risk and adverse outcomes. The cardiovascular benefits of reversing obesity in adults are well-established. Compared with other weight-loss strategies, programmes that incorporate bariatric surgery for weight loss are beneficial for sustained BMI reduction. A marked improvement in cardiovascular risk factors, including hypertension, dyslipidaemia, inflammation, and type 2 diabetes mellitus, has been observed after bariatric surgery. This broad improvement in cardiovascular risk profile has led to substantial reductions in the risk of myocardial infarction, stroke, and death. As with all procedures, the benefits of bariatric surgery must be weighed against its potential risks. Modern bariatric surgery has an excellent safety profile, but important limitations remain, including the potential for surgical complications and nutritional deficiencies, and the lifelong requirement for nutritional supplementation. Surgery should be considered in patients with severe obesity, especially those with cardiovascular comorbidities. In this Review, we summarize the current management options for patients with obesity, and discuss the effects of bariatric surgery on cardiovascular risk factors and outcomes.

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Figure 1: Obesity management flow.
Figure 2: The three most commonly performed bariatric surgical procedures.
Figure 3: Effect of bariatric surgery on cardiovascular deaths in the Swedish Obese Subjects study.

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Acknowledgements

A.J.B. has received research funding from The Royal College of Surgeons of England.

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All authors researched data for the article, discussed its content, and wrote, reviewed, and edited the manuscript before submission.

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Correspondence to Thomas H. Inge.

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T.O. serves as a consultant, advisory board member, and lecturer for Ethicon Endo-Surgery. He has also lectured for AstraZeneca and Sanofi. A.S.K. serves as a consultant for Novo Nordisk Pharmaceuticals and is the signatory author for a paediatric obesity clinical trial sponsored by Novo Nordisk Pharmaceuticals; he does not accept personal or professional income for these activities. He also receives research support from AstraZeneca Pharmaceuticals. T.H.I. has received research grant funding from Ethicon Endo-Surgery and has served as a consultant for Sanofi.

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Beamish, A., Olbers, T., Kelly, A. et al. Cardiovascular effects of bariatric surgery. Nat Rev Cardiol 13, 730–743 (2016). https://doi.org/10.1038/nrcardio.2016.162

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