Coronary Calcium Scores 6 Years After Bariatric Surgery

Abstract

Background Obesity is associated with elevated coronary artery calcium (CAC), a marker of coronary atherosclerosis that is strongly predictive of cardiovascular events. we evaluated the effects of marked weight loss achieved through roux-en-Y gastric bypass surgery (GBS) on CAC scores. Methods We performed echocardiography and computed tomography of the heart in 149 subjects 6 years after enrollment in a prospective registry evaluating the cardiovascular effects of GBS. coronary calcium scores, left ventricular ejection fraction and left ventricular mass were measured. Results At baseline most coronary risk factors were similar between the GBS and nonsurgical groups including current smoking, systolic blood pressure, LDL-C, HDL-C, and TG. However, GBS patients were younger (4.7 years), less likely to be diabetic and less likely to be postmenopausal. At 6 years after enrollment, CAC score was significantly lower in patients who underwent GBS than those without surgery (p<0.01). GBS subjects had a lower likelihood of having measureable coronary calcium (odds ratio of CAC > zero = 0.39; 95% CI of (0.17, 0.90)). Significant predictors of zero CAC were GBS, female gender, younger age, baseline BMI, and baseline LDL-C. Substituting change in BMI for group status as a predictor variable showed that BMI change also predicted CAC (p=0.045). Changes in LDL-C did not predict the CAC differences between groups (p=0.67). Conclusions Sustained weight loss achieved through bariatric surgery is associated with less coronary calcification. This effect, which appears to be independent of changes in LDL-C, may contribute to lower cardiac mortality in patients with successful GBS.

Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)

“…At 6 years after surgery, CAC score was significantly lower in patients who underwent GBP than those patients who did not undergo surgery (P < 0.01. Additionaly GBP subjects had a lower likelihood of having measurable coronary calcium (odds ratio of CAC > 0 = 0.39; 95%CI of (0.17, 0.90) [99]. …”

Improvement of Cardiac Function After Roux-en-Y Gastric Bypass in Morbidly Obese Patients Without Cardiac History Measured by Cardiac MRI

“…Although cardiovascular risks decline due to an improved lipid spectrum, it does not seem to be related to the improvement of cardiac function. Priester et al reported that weight loss achieved through bariatric surgery is associated with less coronary calcification and this effect, which appears to be independent of changes in LDL-C, may contribute to lower cardiac mortality in patients with successful gastric bypass [38]. Additionally, Jonker et al demonstrated that bariatric surgery results in a significant decrease in carotid intima-media thickness in all evaluated age categories, resulting in an improvement of cardiovascular risks [39].…”

How to Choose and Use Bariatric Surgery in 2015

“…170 It was demonstrated that sustained weight loss achieved using bariatric surgery is associated with less coronary calcifications, with a lower coronary artery calcium score, compared with nonsurgical obese patients after 6 years. 171 Moreover, carotid intima-medial thickness measurements performed at baseline and 4 years after surgery showed that obese patients who undergo bariatric surgery had a rate of progression similar to the lean control group, whereas nonsurgical severely obese patients had a rate of progression approximately 3 times greater. 172 Taken together, these data provide evidence that weight loss surgery might, over time, slow the progression of atherosclerosis.…”