The ongoing obesity epidemic represents a global public health crisis that contributes to poor health outcomes, reduced quality of life and >2.8 million deaths each year. Obesity is relapsing, progressive and heterogeneous. It is considered a chronic disease by the World Obesity Federation (WOF) and a chronic condition by the World Heart Federation (WHF). People living with overweight/obesity are at greater risk for cardiovascular (CV) morbidity and mortality. Increased adiposity (body fat), particularly visceral/abdominal fat, is linked to CV risk and CV disease (CVD) via multiple direct and indirect pathophysiological mechanisms. The development of CVD is driven, in part, by obesity-related metabolic, endocrinologic, immunologic, structural, humoral, haemodynamic, and functional alterations. The complex multifaceted nature of these mechanisms can be challenging to understand and address in clinical practice. People living with obesity and CVD often have concurrent chronic physical or psychological disorders (multimorbidity) requiring multidisciplinary care pathways and polypharmacy. Evidence indicates that intentional weight loss (particularly when substantial) lowers CVD risk among people with overweight/obesity. Long-term weight loss and maintenance require ongoing commitment from both the individual and those responsible for their care. This position paper, developed by the WOF and the WHF, aims to improve understanding of the direct and indirect links between overweight/obesity and CVD, the key controversies in this area and evidence relating to cardiometabolic outcomes with available weight management options. Finally, an action plan for clinicians provides recommendations to help in identifying and addressing the risks of obesity-related CVD (recognising resource and support variances between countries).

IntroductionThis systematic review and meta-analysis focuses on PCSK9 changes in obese patients following bariatric surgery.Material and methodsA systematic literature search in four databases was performed.ResultsThe results of meta-analysis on 4 trials including 260 individuals demonstrated a remarkable decline of PCSK9 after bariatric surgery (WMD: -57.34 ng/ml, 95% CI: -87.97, -26.71, p<0.001; I2:96.25%). Consistently, a significant decrease of LDL-C after bariatric surgery (WMD: -22.57 mg/dl, 95% CI: -27.5, -17.574, p<0.001; I2: 86.35%) was observed.ConclusionsPCSK9 is reduced significantly after bariatric surgery. The decrease of PCSK9 might be utilized as an independent surrogate marker of improvement of ASCVD risk after bariatric surgery.