Biliopancreatic diversion with duodenal switch yielded greater reductions in 10-year cardiovascular risk (-1.58) compared to Roux-en-Y gastric bypass (-0.93) and sleeve gastrectomy (-0.33) (p=0.006).
Cohort (n=2,642)
No
Does the type of metabolic and bariatric surgery affect the reduction in estimated cardiovascular risk in adults?
More metabolically intensive bariatric surgeries, such as Roux-en-Y gastric bypass and biliopancreatic diversion, are associated with significantly greater reductions in estimated 10-year and lifetime cardiovascular risk compared to sleeve gastrectomy.
p-value: p=0.006
BACKGROUND: Obesity is a major contributor to atherosclerotic cardiovascular disease through adverse effects on blood pressure, lipid metabolism, and glucose regulation. Metabolic and bariatric surgery produces durable cardiometabolic improvement, but procedures differ in their metabolic effects. Whether these differences translate into meaningful variation in integrated cardiovascular risk reduction remains uncertain. We compared changes in estimated cardiovascular risk following sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. METHODS: We conducted a retrospective cohort study of adults undergoing primary metabolic and bariatric surgery at a tertiary academic center. Patients were required to have complete clinical and laboratory data at baseline and one year after surgery. Ten-year and lifetime atherosclerotic cardiovascular disease risk estimates were calculated using pooled cohort equations. Primary outcomes were absolute changes in estimated ten-year and lifetime cardiovascular risk at one year. Secondary outcomes included percent total body weight loss and changes in blood pressure and lipid parameters. RESULTS: The cohort included 2,642 patients (699 sleeve gastrectomy, 1,813 Roux-en-Y gastric bypass, and 130 biliopancreatic diversion with duodenal switch). At one year, mean ten-year cardiovascular risk decreased by 0.33 after sleeve gastrectomy, 0.93 after Roux-en-Y gastric bypass, and 1.58 after biliopancreatic diversion with duodenal switch (p=0.006). Mean lifetime cardiovascular risk decreased by 3.24, 7.67, and 10.49, respectively (p<0.001). Percent total body weight loss was 23.6%, 31.0%, and 36.8%, respectively (p<0.001). CONCLUSION: Metabolic and bariatric surgery is associated with significant cardiovascular risk reduction, with greater benefit observed after more metabolically intensive procedures.
Ghusn et al. (Wed,) conducted a cohort in Obesity (n=2,642). Metabolic and bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch) vs. Comparison between surgical procedures was evaluated on Absolute changes in estimated ten-year and lifetime cardiovascular risk at one year (p=0.006). Biliopancreatic diversion with duodenal switch yielded greater reductions in 10-year cardiovascular risk (-1.58) compared to Roux-en-Y gastric bypass (-0.93) and sleeve gastrectomy (-0.33) (p=0.006).