Bariatric Surgery and Cardiovascular Risk Factors

Abstract

T he rate of obesity is rising logarithmically, especially in those with severe obesity (body mass index [BMI] Ͼ40 kg/m 2 ). Cardiologists, endocrinologists, internists, family practitioners, and most healthcare professionals are increasingly confronted with the severely obese patient and with postoperative bariatric patients because obesity is associated with significant morbidity and increased mortality. In addition, more adolescents these days are severely obese. Substantial long-term successes of lifestyle modifications and drug therapy have been disappointing in this population. The National Institutes of Health has suggested that surgical therapy be proposed to those patients with BMI Ͼ40 kg/m 2 or Ͼ35 kg/m 2 with serious obesity-related comorbidities such as systemic hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. When indicated, surgical intervention leads to significant improvements in decreasing excess weight and comorbidities that can be maintained over time. These include diabetes mellitus, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction. Recent prospective, nonrandomized, observational, or case-control population studies have also shown bariatric surgery to prolong survival in the severely obese. Different types of bariatric procedures are being performed. Historically, operative mortality was between 0.1% and 2.0% with more recent data not exceeding 1%. Early complications include pulmonary embolus (0.5%), anastomotic leaks (1.0% to 2.5%), and bleeding (1.0%). Late complications include anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation. The number of bariatric operations being performed is increasing tremendously as a result of increasing medical need and the evolution of safer surgical techniques and guidelines. Currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present.

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…However, obese patients may not be able to exercise at sufficient workloads to reverse vascular remodeling. Sustained and substantial weight loss is more reliably attained by bariatric surgery than by lifestyle modifications and medications 145, 146, 147. Importantly, bariatric surgery improves LV relaxation and reverses concentric LV remodeling, with a substantial reduction in LV mass 148, 149, 150.…”

An overview of complications affecting the Central Nervous System following bariatric surgery

“…An anastomosis is performed between the excluded biliopancreatic limb and the alimentary limb 50 cm proximal to the ileocecal valve. 4,12 These are shown in Figure 1. In addition to surgical management, a number of endoscopic procedures have also been developed using intragastric balloons, sutures, malabsorptive techniques as well as botulinum toxin.…”

“…[1][2][3] The terminology of overweight, obesity and severe obesity are continuum of a spectrum. 4 Obesity is among one of the major risk factors for cardiovascular and cancer morbidity and mortality contributing to almost 3 million deaths every year worldwide. 5 It is associated with an increased prevalence of morbidity and reduced life expectancy.…”

“…Surgical therapy for the management of obesity is recommended for people with BMI of ≥40 kg/m 2 or for those with BMI ≥35 kg/m 2 with additional obesity related complications like hypertension, type 2 diabetes mellitus, dyslipidemia, or obstructive sleep apnea. 4 However, tremendous increases in demand for weight loss and the advancement in bariatric surgical procedures and techniques have made BS the most efficacious treatment for morbid obesity. 12 Little over 340,000 bariatric surgeries were performed in the year 2011 by more than 6500 bariatric surgeons across the world.…”

“…13 The primary aims of surgery are restriction of food intake and/or iatrogenic malabsorption of food. 4 A number of mechanisms have been suggested to explain the weight loss accomplished by BS. Restriction of food intake due to small volume of the stomach pouch is a major contributor, resulting in decreased calories.…”