Bariatric surgery was found to significantly reduce carotid intima-media thickness (CIMT) and the risk for cardiovascular disease (CVD) in patients with morbid obesity. These findings from a prospective study were published in Surgical Endoscopy.
The study population included 54 patients aged 20 to 69 years (mean age, 40.8±10.7 years) who were morbidly obese (³35 kg/m2; average body mass index [BMI], 45.9±6.5 kg/m2) and undergoing bariatric surgery at a tertiary reference center between December 2017 and September 2019. Patients were assessed for CIMT at the 6- and 12-month marks post-procedure.
Nearly half of the study participants (42.5%) had comorbid obstructive sleep apnea; 31.4% had hypertension, and 27.7% had diabetes mellitus. The majority of patients underwent a sleeve gastrectomy (54%) while 26% had Roux-en-Y gastric bypass, and 20% one anastomosis gastric bypass.
The average CIMT (0.58±0.08 mm) was assessed. No flow abnormalities were detected in any of the patients. CIMT correlated significantly with age (P =0.33; P =.01), preoperative weight (P =0.34; P =.009), BMI (P =0.31; P =.02), and glycated hemoglobin concentration (P =0.27; P =.04). The average 10-year (4%±5.9%) and lifetime risks (42.3%±16.2%) for death from CVD were estimated.
After the procedures, the mean CIMT reduced at 6 months (0.54±0.08 mm) and at 12 months (0.52±0.1 mm; P =.001). The difference at 6 and 12 months (P for both =.003) was significant compared with the baseline CIMT.
At 12 months, 42 patients were available for follow-up, and 22 of them were eligible for CVD risk assessment. The study authors observed a significant reduction in 10-year CVD risk (1.5%±1.8%; P =.036) and lifetime risk (24.3%±12.4%; P =.004). The lifetime risk slightly increased at 12 months (26%±10.8%) but remained significant when compared with the risk at baseline (P =.006).
At 12 months following the procedure, patients were able to reduce their weight (from 114.4±19.9 kg to 82.7±16.5 kg (P <.0001). Fasting blood sugar was significantly reduced (from 107±25 mg/dl to 89±9 mg/dl) at 12 months in the overall population (P <.0001). Glycated hemoglobin levels similarly decreased (from 6.2%±0.8% at baseline to 5.4%±0.4%) at 12 months (P <.0001).
Eight of the patients with diabetes and 5 of the patients with hypertension achieved complete remission, while 1 patient with diabetes and 6 patients with hypertension had a partial remission at 12 months.
CIMT reduction had significant correlation with reduced serum cholesterol (P, =0.42; P =.042), low-density lipoprotein cholesterol (P =0.46; P =.027), and 10-year CVD risk (P =-0.469; P =.0275).
The major limitations of this study included the small sample size and the lack of a control group. “However, our study did not have very strict inclusion criteria, and therefore, our results can be considered fairly generalizable to all patients undergoing bariatric surgery,” the study authors wrote. They concluded that bariatric surgery, regardless of type, led to “significant improvement” in CIMT and CVD risk in patients considered morbidly obese.
Kaul A, Kumar A, Baksi A, et al. Impact of bariatric surgery on carotid intima‑medial thickness and cardiovascular risk: results of a prospective study. Surg Endosc. Published online October 13, 2020] doi: 10.1007/s00464-020-08088-0