Is obesity a predictor of mortality, morbidity and readmission after cardiac surgery? Bariatric surgery and long-term cardiovascular events. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Cardiac procedures in patients with a body mass index exceeding 45: outcomes and long-term results. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention Evaluation of Current Eligibility Criteria for Bariatric Surgery National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. Relationship of body mass index with outcomes after coronary artery bypass graft surgery. Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4. Effects of bariatric surgery on mortality in Swedish obese subjects. Impact of Body Mass Index on Perioperative Outcomes in Patients Undergoing Major Intra-abdominal Cancer Surgery 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. Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity
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 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 BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline BACKGROUND Obesity has become a public health crisis . Although prior studies in obese patients undergoing cardiac surgical procedures have shown variable effects on outcomes , data are limited for extremely obese patients ( body mass index [ BMI ] > or = 45 ) . We undertook this study to evaluate outcomes in this cohort . METHODS A retrospective analysis was performed on 14,571 patients in our data base who underwent cardiac operations from 1992 to 2005 . Patient demographics , comorbidities , and outcomes were recorded . A univariate analysis between two groups : BMI 21 to 34.9 and BMI 45 or more was performed . Logistic regression models were used to identify independent risk factors for 30-day mortality . Long-term follow-up of the extreme obese group was achieved . RESULTS We identified 128 extreme obese patients , and 480 patients with a BMI of 21.0 to 34.9 were r and omly selected for comparison . Univariate analysis showed significant differences in age , gender , and multiple comorbidities , as well as in cardiopulmonary bypass and cross-clamp times , operative procedure , and transfusion requirements . Extreme obese patients had a higher incidence of infection , acute renal failure , and 30-day mortality . Logistic regression analysis showed BMI , preoperative renal insufficiency , and transfusion status to be independent risk factors for 30-day mortality . Follow-up data did not reveal significant functional improvements . Long-term survival was 33.6 % at 12 years . CONCLUSIONS Extreme obese patients undergoing cardiac surgical procedures have higher perioperative morbidity and mortality compared with a lower BMI group . BMI and preoperative renal insufficiency increase mortality in both groups , whereas transfusion does so only in the extreme obese . These patients can realize acceptable outcomes from cardiac procedures , but continue to suffer from the comorbidities of obesity 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 OBJECTIVE Patients with a BMI < 35 kg/m2 and patients with a BMI between 35 and 40 kg/m2 without comorbidities are noneligible by current eligibility criteria for bariatric surgery .  We used Swedish obese subjects ( SOS ) to explore long-term outcomes in noneligible versus eligible patients . RESEARCH DESIGN AND METHODS The SOS study involved 2,010 obese patients who underwent bariatric surgery ( 68 % vertical-b and ed gastroplasty , 19 % b and ing , and 13 % gastric bypass ) and 2,037 contemporaneously matched obese controls receiving usual care .  At inclusion , the participant age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women . The effect of surgery was assessed in patients that do ( n = 3,814 ) and do not ( n = 233 ) meet current eligibility criteria . The date of analysis was 1 January 2012 . The follow-up time was up to 20 years , with a median of 10 years . RESULTS Cardiovascular risk factors were significantly improved both in noneligible and eligible individuals after 10 years of follow-up . Surgery reduced the diabetes incidence in both the noneligible ( adjusted hazard ratio 0.33 [ 95 % CI 0.13–0.82 ] , P = 0.017 ) and eligible ( 0.27 [ 0.22–0.33 ] , P < 0.001 ) groups . We could not detect a difference in the effect of surgery between the groups ( adjusted interaction P value = 0.713 ) . CONCLUSIONS Bariatric surgery drastically reduced the incidence of type 2 diabetes both in noneligible and eligible patients and improved cardiovascular risk factors in both groups . Our results show that strict BMI cutoffs are of limited use for bariatric surgery prioritization if the aim is to prevent diabetes and improve cardiovascular risk factors 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 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 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 AIMS To evaluate the effect of weight loss after bariatric surgery ( BS )  on peripheral adipocytokines , renal parameters and other cardiovascular risk factors ( CVRFs ) . METHODS A total of 70 ( 41 women ) extremely obese adults were prospect ively studied before and 12 months after surgery . CONTROLS 24 ( 15 women ) normal-weight adults .  Anthropometric , biochemical and renal parameters were recorded . RESULTS Presurgery , adiponectin ( ADPN ) was lower , whereas leptin , insulin resistance , C-reactive protein , creatinine clearance and albuminuria were higher in patients than controls ( P<0.001 ) . All parameters improved postsurgery . Changes in ADPN correlated negatively with leptin , insulin resistance , albumin , C-reactive protein , and creatinine clearance . Multiple regression analysis : using changes in ADPN as the dependent variable , only changes in insulin resistance ( P=0.005 ) and albumin ( P=0.019 ) were significant independent determinants for changes in ADPN . No statistical differences were found in relation to the degree of obesity . CONCLUSION Patients changed to obesity type I after surgery . This implies a substantial improvement of CVRFs including ADPN , creatinine clearance and albuminuria . Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters . The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved , unemployed patients with severe obesity . Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed . Preoperative patient question naires and medical records were review ed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team . Follow-up data was obtained on all available patients ( including those who did not undergo surgery ) , including weight and employment status . A st and ardized telephone question naire was administered to supplement details regarding employment . Changes in employment status and body weight were determined in both groups . Results Here , 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team . The vast majority of patients ( > 80 % ) were minorities ( primarily Hispanic ) and publicly insured . Seventy-two underwent bariatric surgery and 121 did not . Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively ( p = 0.043 ) . There was a 10-point body mass index reduction in the surgical group , compared to 1-point reduction in the non-surgical group after one year . Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort . Future research in this area should collect detailed prospect i ve data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery 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 Background Obesity is an increasingly common serious chronic health condition . We sought to determine the impact of body mass index ( BMI ) on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery .  Methods A prospect i ve , multi-institutional , risk-adjusted cohort study of patients undergoing major intra-abdominal cancer surgery was performed from the 14 university hospitals participating in the Patient Safety in Surgery Study of the National Surgical Quality Improvement Program ( NSQIP ) . Demographic , clinical , and intraoperative variables and 30-day morbidity and mortality were prospect ively collected in st and ardized fashion . Analysis of variance , Bonferroni multiple comparisons of means tests , and multivariable logistic regression analysis were performed . Results We identified 2258 patients who underwent esophagectomy ( n = 29 ) , gastrectomy ( n = 223 ) , hepatectomy ( n = 554 ) , pancreatectomy ( n = 699 ) , or low anterior resection/proctectomy ( n = 753 ) . Patients were stratified by National Institutes of Health (NIH)-defined BMI obesity class , with 573 ( 25.4 % ) patients classified as obese ( BMI > 30 kg/m2 ) . There were no differences in mean work relative value units , total time of operation , or length of stay amongst the BMI classes . After adjusting for other risk factors , obesity was not a risk factor for death or major complications but was a risk factor for wound complications . The risk of postoperative death was greatest in underweight patients ( odds ratio [ OR ] 5.24 ; 95 % confidence interval [ CI ] 1.7–16.2 ) . Conclusion In patients undergoing major intra-abdominal cancer surgery , obesity is not a risk factor for postoperative mortality or major complications . Importantly , underweight patients have a fivefold increased risk of postoperative mortality , perhaps a consequence of their underlying nutritional status 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 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 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
Using mean data from the validation study , the trend and directionality in risk was similar in the Roux-en-Y group .
In conclusion , bariatric surgery predicts long-term decreases in CV risk in obese patients
Obese patients have an increased prevalence of  cardiovascular ( CV ) risk factors , which improve with bariatric surgery , but whether bariatric surgery reduces long-term CV events remains ill defined .