Is obesity a predictor of mortality, morbidity and readmission after cardiac surgery? Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention Bariatric surgery and long-term cardiovascular events. The relationship between obesity and atherosclerotic progression and prognosis among patients with coronary artery bypass grafts the effect of aggressive statin therapy. Effects of bariatric surgery on mortality in Swedish obese subjects. Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year The effect of obesity and weight loss on aortic pulse wave velocity as assessed by magnetic resonance imaging. Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Obesity paradox in coronary artery bypass grafting: myth or reality? Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis. Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. Effects of intentional weight loss in patients with obesity and heart failure: a systematic review. Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes.
INTRODUCTION Obesity has been described as a risk factor for the development of coronary artery disease , but it has not been determined whether obesity is associated with adverse outcomes after cardiac surgery . Therefore , we analyzed a large cohort of patients who had undergone cardiac surgery to determine whether obesity is a predictor of mortality , morbidity or early readmission to hospital . METHODS At the London Health Sciences Centre , an academic tertiary care centre , we prospect ively entered data from the cardiac surgical data base from July 1999 to April 2002 . We collected data on 1310 consecutive , unselected patients who underwent cardiac surgery during that time . We assessed the degree of obesity using the body mass index ( BMI ) , and we prospect ively documented the occurrence of 10 major complications after surgery . They included stroke , reoperation for bleeding , life-threatening cardiac arrest or arrhythmia , new renal failure requiring dialysis , septicemia , mediastinitis , sternal dehiscence , respiratory failure , postoperative myocardial infa rct ion and low cardiac output necessitating intra-aortic balloon pump use . Univariable and multivariable analyses were conducted to determine the factors associated with and predictive of postoperative death and major complications . RESULTS An increased BMI did not increase the risk of early postoperative death . Furthermore , increased BMI was not a predictor of a patient experiencing any of the major complications , except sternal dehiscence . An increased BMI was associated with a higher likelihood of readmission to hospital within 30 days of discharge . CONCLUSION Obesity was not associated with adverse outcomes after cardiac operations , aside from the increased risks of sternal dehiscence and early hospital readmission Context : The benefit of weight reduction for cardiovascular disease ( CVD ) outcomes remains uncertain . Objective : To examine the effects of baseline body mass index on major CVD outcomes and diabetes over a 20 year follow up , and of weight change in the first five years over the subsequent 15 years . Design and setting : A prospect i ve study of British men followed up for 20 years . Participants : Men aged 40–59 years with no diagnosis of CVD or diabetes ( n = 7176 ) of whom 6798 provided full information on weight change five years later . Outcome measures : Major CVD events ( fatal and non-fatal myocardial infa rct ion and stroke , angina , “ other ” CVD deaths ) and diabetes . Results : During the 20 year follow up there were 1989 major CVD events and 449 incident cases of diabetes in the 7176 men . Risk of major CVD and diabetes increased significantly with increasing overweight and obesity . During the 15 year follow up , weight gain was associated with increased risk of CVD and diabetes . Weight loss was associated with lower risk of diabetes than the stable group irrespective of initial weight . No significant cardiovascular benefit was seen for weight loss in any men , except possibly in considerably overweight ( BMI 27.5–29.9 kg/m2 ) younger middle aged men ( RR = 0.42 ; 95 % CI 0.22 to 0.81 ) . Conclusion : Long term risk of CVD and diabetes increased significantly with increasing overweight and obesity . Weight loss was associated with significant reduction in risk of diabetes but not CVD , except possibly in considerably overweight younger men . Duration and severity of obesity seem to limit the cardiovascular benefits of weight reduction in older men Objective Weight reduction improves several obesity-related health conditions . We aim ed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors . Design One-year controlled clinical trial ( Clinical Trials.gov identifier NCT00273104 ) . Methods Morbidly obese subjects ( 19–66 years , mean ( s.d . ) body mass index 45.1 kg/m2 ( 5.6 ) , 103 women ) were treated with either Roux-en-Y gastric bypass surgery ( n=80 ) or intensive lifestyle intervention at a rehabilitation centre ( n=66 ) . The dropout rate within both groups was 5 % . Results Among the 76 completers in the surgery group and the 63 completers in the lifestyle group , mean ( s.d . ) 1-year weight loss was 30 % ( 8) and 8 % ( 9 ) respectively . Beneficial effects on glucose metabolism , blood pressure , lipids and low- grade inflammation were observed in both groups . Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group ; 70 vs 33 % , P=0.027 , and 49 vs 23 % , P=0.016 . The improvements in glycaemic control and blood pressure were mediated by weight reduction . The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome , albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group . Gastrointestinal symptoms and symptomatic postpr and ial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention . There were no deaths . Conclusions Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies . However , the improvements were greatest in those patients treated with gastric bypass surgery CONTEXT Obesity is a risk factor for cardiovascular events . Weight loss might protect against cardiovascular events , but solid evidence is lacking . OBJECTIVE To study the association between bariatric surgery , weight loss , and cardiovascular events . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) study is an ongoing , nonr and omized , prospect i ve , controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care . Patients were recruited between September 1 , 1987 , and January 31 , 2001 . Date of analysis was December 31 , 2009 , with median follow-up of 14.7 years ( range , 0 - 20 years ) . Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women . Exclusion criteria were identical in surgery and control patients . Surgery patients underwent gastric bypass ( 13.2 % ) , b and ing ( 18.7 % ) , or vertical b and ed gastroplasty ( 68.1 % ) , and controls received usual care in the Swedish primary health care system . Physical and biochemical examinations and data base cross-checks were undertaken at preplanned intervals . MAIN OUTCOME MEASURES The primary end point of the SOS study ( total mortality ) was published in 2007 . Myocardial infa rct ion and stroke were predefined secondary end points , considered separately and combined . RESULTS Bariatric surgery was associated with a reduced number of cardiovascular deaths ( 28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group ; adjusted hazard ratio [ HR ] , 0.47 ; 95 % CI , 0.29 - 0.76 ; P = .002 ) . The number of total first time ( fatal or nonfatal ) cardiovascular events ( myocardial infa rct ion or stroke , whichever came first ) was lower in the surgery group ( 199 events among 2010 patients ) than in the control group ( 234 events among 2037 patients ; adjusted HR , 0.67 ; 95 % CI , 0.54 - 0.83 ; P < .001 ) . CONCLUSION Compared with usual care , bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults OBJECTIVES This study examines whether obesity accelerates atherogenic progression or adverse outcomes after coronary artery bypass graft ( CABG ) surgery . BACKGROUND Obesity is a major risk factor for developing coronary heart disease . Whether obesity accelerates disease progression after CABG is unclear . METHODS We examined how body mass index ( BMI ) related to atherosclerotic graft progression and a clinical composite outcome of death , nonfatal myocardial infa rct ion , stroke , CABG surgery , or angioplasty among 1,314 participants in the Post CABG trial . Participants who had undergone CABG surgery were r and omly assigned in a 2 x 2 factorial design to warfarin versus placebo and aggressive low-density lipoprotein cholesterol ( LDL-C ) lowering with lovastatin 40 to 80 mg/day ( to achieve LDL-C of 60 to 85 mg/dl ) versus moderate LDL-C lowering with lovastatin 2.5 to 5 mg/day ( to achieve LDL-C of 130 to 140 mg/dl ) . Angiographic progression was assessed by coronary angiography at 4 to 5 years . RESULTS Higher BMI was associated with a higher likelihood of angiographic progression ( p trend = 0.003 ) after adjustment for demographic factors , treatment assignment , smoking status , and years since CABG surgery , but not with clinical events ( p trend = 0.81 ) . In stratified analyses , higher BMI was associated with angiographic progression in the low-dose lovastatin group ( p trend < 0.001 ) but not in the high-dose group ( p = 0.03 for test for interaction of BMI and statin treatment ) . In the high-dose lovastatin group , higher BMI appeared to be protective against clinical events ( p trend = 0.06 , test of interaction : 0.02 ) . CONCLUSIONS Higher BMI is strongly associated with atherogenic progression after CABG surgery . Aggressive statin therapy may be protective against obesity-related acceleration of coronary heart disease BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality Importance Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes , and medical management , including lifestyle changes , may not be successful at lowering risk . Objective To investigate the relationship between bariatric surgery and incident macrovascular ( coronary artery disease and cerebrovascular diseases ) events in patients with severe obesity and type 2 diabetes . Design , Setting , and Participants In this retrospective , matched cohort study , patients with severe obesity ( body mass index ≥35 ) aged 19 to 79 years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4 integrated health systems in the United States ( n = 5301 ) were matched to 14 934 control patients on site , age , sex , body mass index , hemoglobin A1c , insulin use , observed diabetes duration , and prior health care utilization , with follow-up through September 2015 . Exposures Bariatric procedures ( 76 % Roux-en-Y gastric bypass , 17 % sleeve gastrectomy , and 7 % adjustable gastric b and ing ) were compared with usual care for diabetes . Main Outcomes and Measures Multivariable-adjusted Cox regression analysis investigated time to incident macrovascular disease ( defined as first occurrence of coronary artery disease [ acute myocardial infa rct ion , unstable angina , percutaneous coronary intervention , or coronary artery bypass grafting ] or cerebrovascular events [ ischemic stroke , hemorrhagic stroke , carotid stenting , or carotid endarterectomy ] ) . Secondary outcomes included coronary artery disease and cerebrovascular outcomes separately . Results Among a combined 20 235 surgical and nonsurgical patients , the mean ( SD ) age was 50 ( 10 ) years ; 76 % of the surgical and 75 % of the nonsurgical patients were female ; and the baseline mean ( SD ) body mass index was 44.7 ( 6.9 ) and 43.8 ( 6.7 ) in the surgical and nonsurgical groups , respectively . At the end of the study period , there were 106 macrovascular events in surgical patients ( including 37 cerebrovascular and 78 coronary artery events over a median of 4.7 years ; interquartile range , 3.2 - 6.2 years ) and 596 events in the matched control patients ( including 227 cerebrovascular and 398 coronary artery events over a median of 4.6 years ; interquartile range , 3.1 - 6.1 years ) . Bariatric surgery was associated with a lower composite incidence of macrovascular events at 5 years ( 2.1 % in the surgical group vs 4.3 % in the nonsurgical group ; hazard ratio , 0.60 [ 95 % CI , 0.42 - 0.86 ] ) , as well as a lower incidence of coronary artery disease ( 1.6 % in the surgical group vs 2.8 % in the nonsurgical group ; hazard ratio , 0.64 [ 95 % CI , 0.42 - 0.99 ] ) . The incidence of cerebrovascular disease was not significantly different between groups at 5 years ( 0.7 % in the surgical group vs 1.7 % in the nonsurgical group ; hazard ratio , 0.69 [ 95 % CI , 0.38 - 1.25 ] ) . Conclusions and Relevance In this observational study of patients with type 2 diabetes and severe obesity who underwent surgery , compared with those who did not undergo surgery  , bariatric surgery was associated with a lower risk of macrovascular outcomes . The findings require confirmation in r and omized clinical trials . Health care professionals should engage patients with severe obesity and type 2 diabetes in a shared decision making conversation about the potential role of bariatric surgery in the prevention of macrovascular events Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions Obesity is an escalating global health problem associated with both an increased risk of death and an increased risk of cardiovascular events . Our goal was to use magnetic resonance imaging ( MRI ) to determine the effect of obesity and weight loss , in the absence of the traditional cardiovascular risk factors , on aortic pulse wave velocity ( PWV ) a reliable , reproducible , and accurate clinical measure of aortic stiffness linked to increased mortality . Fifty obese ( BMI 38.3 ± 6.8 kg/m(2 ) ) and eighteen normal-weight controls ( BMI 22.0 ± 1.7 kg/m(2 ) ) with no identifiable cardiovascular risk factors underwent  vascular MRI  to assess PWV between the ascending aorta at the level of the pulmonary artery and the abdominal aorta ( AA ) . Twenty-eight subjects underwent repeat imaging after a 1-year period of weight loss . Both groups were well matched for age , systolic blood pressure , fasting glucose , and total cholesterol . Obesity was associated with a 14 % increase in PWV ( P = 0.021 ) , and with elevated C-reactive protein ( CRP ) ( P < 0.01 ) and leptin levels ( P < 0.001 ) factors known to cause increase arterial stiffness . Weight loss ( average 50 % excess weight ) was associated with a 14 % improvement in PWV ( P = 0.03 ) , and with reductions in serum leptin levels ( P < 0.01 ) . Obesity , in the absence of the traditional cardiovascular risk factors , is associated with increased aortic PWV , a noninvasive clinical measure of aortic stiffness independently predictive of cardiovascular mortality . Significant weight loss results in improvements in aortic PWV . This may provide a potential link between both obesity and increased mortality , and the reduction in mortality that occurs with weight loss BACKGROUND A debate exists whether obesity is a risk factor for operative mortality after  coronary artery bypass graft surgery ( CABG ) . The contradictory findings in the literature may largely be attributable to the variety of method ological approaches used to model the association between body mass index ( BMI ) and post-CABG outcomes . This study aims to investigate this association , and to uncover possible explanations for the lack of consensus across prior studies . METHODS Data were prospect ively collected on 80,792 patients who underwent a CABG procedure during a 14-year period at the 45 Department of Veterans Affairs cardiac surgery programs .  Generalized additive models were used to estimate the relationship of BMI and outcomes after a CABG procedure . RESULTS We found that the relationship of BMI with post-CABG mortality and morbidity is U-shaped with the minimum risk located around a BMI of 30 kg/m2 , indicating that patients classified as overweight have the lowest risk , and those in the lower end of the obese range do not have seriously elevated risk . This U-shape relationship is significantly nonlinear and robust to adjustment for other risk factors . CONCLUSIONS This study demonstrates that BMI is an independent predictor of mortality and morbidity after CABG surgery . Previous studies that model BMI linearly or as categories can not accurately capture this U-shaped relationship and are unlikely to find a significant contribution by including BMI . Further research is needed to determine the mechanisms of risk for patients with low and high BMI and whether interventions to modify BMI may improve patient outcomes OBJECTIVE A high body mass index has been suggested to be protective in patients with coronary artery disease and in those undergoing coronary artery bypass grafting ( CABG ) .  However , these conflicting results might be related to the different risk profiles among the various body mass index categories . We sought to clarify the effect of varying degrees of excessive body weight on hard clinical outcomes in patients undergoing CABG .  METHODS A retrospective analysis of prospect ively collected data was conducted to investigate the effect of a high body mass index on early and late mortality after  first-time isolated CABG . Propensity score matching was used to adjust for confounding factors . RESULTS The study sample consisted of 3269 normal weight , 6662 overweight , 3821 obese , and 211 morbidly obese patients . After matching , early mortality was not affected by overweight ( mean difference , 0.7 % ; 95 % confidence interval [ CI ] , -0.2 % to 1.5 % ) , obesity ( mean difference , 0.5 % ; 95 % CI , -0.7 % to 1.7 % ) , and morbid obesity ( mean difference , 1.6 % ; 95 % CI , -1.0 % to 1.0 % ) , regardless of the patients ' risk profile according to the European system for cardiac operative risk evaluation . Overweight status was not protective for late death ( hazard ratio , 1.05 ; 95 % CI , 0.9 - 1.08 ; P = .4 ) . Compared with normal weight patients , both obese and morbidly obese patients had a higher risk of late death ( hazard ratio , 1.22 ; 95 % CI , 1.07 - 2.66 ; P = .006 for obese patients ; hazard ratio , 1.36 ; 95 % CI , 0.74 - 2.49 ; P = .3 for morbidly obese patients ) . CONCLUSIONS Obesity did not increase operative mortality , but it was associated with reduced late survival in patients undergoing primary isolated CABG . Our results raise concerns in supporting any protective effect of obesity in cardiovascular disease , specifically in patients undergoing surgical myocardial revascularization AIM Explore the relation between body mass index ( BMI ) and cardiovascular disease , and the influence of optimal medical therapy ( OMT ) on this relationship . METHODS AND RESULTS Patients from the REACH cohort , an international , prospect i ve cohort of patients with or at high risk of atherosclerosis with documentation of potential confounders , including treatments and risk factors , were followed up to 4 years ( n = 54 285 ) . Patients were categorized according to baseline BMI ( ranging from underweight to Grade III obesity ) . Optimal medical therapy was defined as the use of the four cardioprotective medication classes ( statins , ACE inhibitors/angiotensin II receptor blockers , β-blockers , and antiplatelet agents ) . The main outcomes were all-cause mortality , cardiovascular ( CV ) mortality , and CV events . In primary and secondary prevention , a reverse J-shaped curve best described the relationship between BMI categories and the incidence of the various outcomes . In secondary prevention , the highest adjusted risks were observed for underweight patients ( 1.97 , P < 0.01 , and 1.29 , P = 0.03 , for CV mortality and CV events ) and the lowest HRs were observed , respectively , in Grade II and Grade III obese patients ( 0.73 , P < 0.01 and 0.80 , P < 0.01 ) . The proportion of patients on OMT increased with BMI from 10.1 to 36 % ( P < 0.001 ) . The apparent CV protection conferred by obesity persisted in patients receiving OMT . CONCLUSION An obesity paradox was observed in both primary and secondary CV prevention patients . The intensity of use of evidence -based preventive medications does not account for the paradoxical CV protection associated with obesity . At extremes of BMI , further interventions beyond OMT may be needed to reduce CV risk OBJECTIVE The aim of this study was to investigate the predictive value for all-cause and cardiovascular ( CV ) death of anthropometric measurements of abdominal obesity in patients with end-stage renal disease ( ESRD ) . BACKGROUND Surrogate measures of abdominal obesity and segmental fat distribution ( waist circumference and waist/hip ratio [ WHR ] ) are stronger predictors of all-cause and CV death than body mass index ( BMI ) in the general population , but the issue has never been investigated in patients with ESRD . METHODS We performed a prospect i ve cohort study in 537 patients with ESRD ( age 63 + /- 15 years ) . RESULTS In BMI -adjusted Cox models , waist circumference was a direct predictor of all-cause and CV mortality ( p < 0.001 ) , whereas BMI showed an inverse relationship ( p < 0.001 ) with these outcomes . The incidence rates of overall and CV death were maximal in patients with relatively lower BMI scores ( below the median ) and higher waist circumferences ( at least the median ) and minimal in patients with higher BMI scores ( at least the median ) and small waist circumferences ( below the median ) . The prognostic power of waist circumference for all-cause ( hazard ratio [ HR ] [ 10-cm increase ] : 1.23 ; 95 % confidence interval [ CI ] : 1.02 to 1.47 ; p = 0.03 ) and CV mortality ( HR : 1.37 ; 95 % CI : 1.09 to 1.73 ; p = 0.006 ) remained significant after adjustment for CV comorbidities and traditional and emerging risk factors . WHR was found to be related to all-cause ( p = 0.009 ) and CV mortality ( p = 0.07 ) . CONCLUSIONS Abdominal obesity underlies a high risk of all-cause and CV mortality in patients with ESRD . Redefinition of nutritional status by combining the metrics of abdominal obesity and BMI may refine prognosis in the ESRD population BACKGROUND Very few studies have compared laparoscopic Roux-en-Y gastric bypass ( LRYGB ) and laparoscopic sleeve gastrectomy ( LSG ) outcomes or analyzed improvement in cardiovascular risk ( CVR ) after bariatric surgery . None of the studies considered the Mediterranean population . Our primary objective was to compare the 10-year estimated CVR reduction achieved by LRYGB and LSG in Spanish subjects with severe obesity . The secondary objectives were to compare the techniques in terms of weight loss and co-morbidity improvement . The study was performed at a university hospital in Barcelona , Spain . METHODS A 12-month prospect i ve cohort study of 140 consecutive patients ( 95 LRYGB and 45 LSG ) compared the 2 surgical intervention groups to study the percentage of excess weight loss , resolution and improvement/resolution of co-morbidities , and effect on CVR using both the Framingham risk score ( FRS ) and the Registre Gironí del Cor ( REGICOR ) model . RESULTS At 12 months , the overall CVR decreased from 6.6 % to 3.4 % using the FRS and from 3.7 % to 1.9 % using the REGICOR score . Neither model found a difference between the 2 surgical intervention groups in decreased postoperative CVR risk , with a FRS of 3.4 % ± 2.2 % for LRYGB versus 3.3 % ± 2.1 % for LSG ( P = .872 ) and a REGICOR score of 1.9 % ± 1.5 % versus 1.8 % ± 1.6 % , respectively ( P = .813 ) . No differences were observed in the percentage of excess weight loss or the resolution of type 2 diabetes mellitus and hypertension . The hypercholesterolemia improvement/resolution rate was lower in the LSG group than in the LRYGB group . CONCLUSION Bariatric surgery reduces the estimated CVR by one half at 1 year after surgery . Except for the less-improved cholesterol metabolism , LSG , a restrictive technique , proved to be equally as effective at 1 year of follow-up as LRYGB BACKGROUND The increase in obesity coupled with greater acceptance of the field of bariatric surgery has result ed in a substantial rise in the number of weight-loss operations . Because obese individuals are at high risk for surgical complications , concern about the safety of bariatric procedures exists . Earlier investigations of the clinical features associated with surgical complications have produced conflicting results . We sought to identify risk factors for surgical complications in a large , nationally representative population of US veterans . STUDY DESIGN We analyzed data  on bariatric procedures performed at 12 Veterans ' Affairs medical centers approved to perform weight-loss operations between 1998 and 2004 . Detailed pre- , intra- , and postoperative information and longterm mortality data were prospect ively collected using the National Surgical Quality Improvement Program methodology . We used multivariable logistic regression to identify clinical features associated with postoperative complications . RESULTS Among 575 bariatric patients assessed between 1998 and 2004 , 74 % were men with a mean age of 51 years . Thirty-day mortality was 1.4 % . Overall complication rate was 19.7 % . Of those with complications , one-half were of considerable clinical importance , as they were associated with prolonged length of stay . Clinical features that were predictive of adverse events in our multivariable analyses were superobesity , weight>350 pounds , and smoking . A more than 20 pack-year history of smoking was also associated with difficulty in weaning from a ventilator postoperatively . CONCLUSIONS We identified smoking and superobesity as preoperative risk factors associated with postoperative complications . Future studies should examine the effect of preoperative weight loss and smoking cessation on bariatric procedure outcomes OBJECTIVE Obesity is an independent risk factor for the development of heart failure , and the two commonly co-exist . The European Society of Cardiology does not provide guidance regarding weight loss strategies in heart failure . The aim of this study was to systematic ally review the evidence for outcomes following intentional weight loss in patients with heart failure and obesity . METHOD A systematic review of English articles was undertaken using data bases PubMed , Embase and CENTRAL . R and omized controlled trials and observational studies reporting outcomes following intentional weight loss by lifestyle , surgical or pharmacotherapy intervention in patients with obesity and heart failure were included . RESULTS Four r and omized controlled trials and seven observational studies were identified . Two r and omized controlled trials used  diet and exercise  as an intervention , one used diet alone and one used a pharmacological intervention ( orlistat ) . All but one reported significant weight loss . Two reported improvement in exercise capacity and quality of life . One reported improvement in New York Heart Association functional class in heart failure with preserved ejection fraction . The observational studies , five of which reported on outcomes following bariatric surgery , despite being small , heterogeneous and high risk of bias , suggested a trend in improvement of left ventricular function , quality of life and exercise capacity following weight loss . CONCLUSION Weight loss is achievable with lifestyle intervention in those with heart failure and obesity and may result in improvements in New York Heart Association classification , quality of life and exercise capacity Overweight and obesity are major contributors to both type 2 diabetes and cardiovascular disease ( CVD ) . Moreover , individuals with type 2 diabetes who are overweight or obese are at particularly high risk for CVD morbidity and mortality . Although short-term weight loss has been shown to ameliorate obesity-related metabolic abnormalities and CVD risk factors , the long-term consequences of intentional weight loss in overweight or obese individuals with type 2 diabetes have not been adequately examined . The primary objective of the Look AHEAD clinical trial is to assess the long-term effects ( up to 11.5 years ) of an intensive weight loss program delivered over 4 years in overweight and obese individuals with type 2 diabetes . Approximately 5000 male and female participants who have type 2 diabetes , are 45 - 74 years of age , and have a body mass index > or=25 kg/m(2 ) will be r and omized to one of the two groups . The intensive lifestyle intervention is design ed to achieve and maintain weight loss through decreased caloric intake and increased physical activity . This program is compared to a control condition given diabetes support and education . The primary study outcome is time to incidence of a major CVD event . The study is design ed to provide a 0.90 probability of detecting an 18 % difference in major CVD event rates between the two groups . Other outcomes include components of CVD risk , cost and cost-effectiveness , diabetes control and complications , hospitalizations , intervention processes , and quality of life
In conclusion , this review highlights the benefits of bariatric surgery in reducing or eliminating risk factors for CVD .
It provides further evidence to support surgical treatment of obesity to achieve CVD risk reduction
Obesity is associated with increased risk for cardiovascular ( CV ) disease ( CVD ) and CV mortality .
Bariatric surgery has been shown to resolve or improve CVD risk factors , to varying degrees .
The objective of this systematic review was to determine the impact of bariatric surgery on CV risk factors and mortality .
A systematic review of the published research was performed to evaluate evidence regarding CV outcomes in morbidly obese bariatric patients .