Effect of gastric bypass operation on Framingham and actual risk of cardiovascular events in class II to III obesity.
ABSTRACT Obesity is known to be a major risk factor for cardiovascular diseases. There are few studies in the literature assessing the effect of bariatric procedures on longterm risk of cardiovascular events. The aim of this study was to determine the effect of gastric bypass operation on actual and Framingham risk of coronary heart disease (CHD) events in class II to III obesity.
In a cohort of subjects with class II to III obesity, we used the observed change in CHD risk factors and risk models derived from the Framingham data equation to calculate the predicted 10-year absolute and relative risk of CHD after gastric bypass operation. The risk predicted by the Framingham model was then compared with the actual incidence of CHD events of the cohort.
Five-hundred patients were included in the study. The 1-year mean excess body weight loss was 68.7% +/- 22%. There was a substantial reduction in prevalence of diabetes from 28% to 6% (p = 0.001). Compared with baseline, the average 10-year absolute risk of cardiac events decreased from 5.4% at baseline to 2.7% at 1 year after operation (p = 0.001). A similar risk reduction was observed in subgroups defined by diabetes status and gender. Gastric bypass decreased absolute risk of cardiac events by a mean of 63% (p = 0.0001) in diabetics and 56% (p = 0.001) in male patients. The cohort actual rate of CHD events was 1% (5 of 500). At the 5-year horizon, this was considerably (p = 0.001) lower than the predicted rate before gastric bypass operation.
Gastric bypass operation is effective in reducing actual and the 10-year Framingham risk of CHD events in individuals with class II to III obesity. The major estimated risk reduction was observed in male patients with type 2 diabetes.
SourceAvailable from: Carlos Bravo Torreblanca[Show abstract] [Hide abstract]
ABSTRACT: Introduction: Obesity has been considered a risk factor for acute coronary events. The main factors to develop this type of diseases are present in most of the patients subjected to bariatric surgery.09/2012; 34(3):162-168.
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ABSTRACT: Roux-en-Y gastric bypass (RYGB) reduces most of the obesity-related comorbidities known to increase the cardiovascular risk in obese subjects. The Framingham risk score (FRS) is designed to be independent of body weight and estimates the 10-year risk for coronary heart disease (CHD), myocardial infarction, stroke, cardiovascular disease (CVD), death from CHD, and death from CVD. Our aim was to evaluate the effectiveness of RYGB on improving the FRS when compared to a matched control group who underwent diabetes support and education program (DSE).Surgical Endoscopy 05/2014; 28(10). DOI:10.1007/s00464-014-3550-6 · 3.31 Impact Factor
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ABSTRACT: Background: The authors' earlier retrospective report of surgical complications after abdominal contouring surgery provided evidence that post-bariatric surgery patients are at increased risk of developing wound complications compared with a normal population. This prospective pilot study was designed as a comparative analysis of both surgical and wound healing characteristics between massive weight loss and normal patients who present for abdominal contouring surgery. Methods: Excisional wounds were created and polytetrafluoroethylene tubing was inserted during the preoperative period for later harvesting in patients undergoing abdominal contouring following Roux-en-Y gastric bypass for weight loss (n = 16) or abdominoplasty (n = 17). Wound fluids were sequentially collected from drains and subjected to matrix metalloproteinase (MMP) analysis. Standard postsurgical complications were documented. Results: Surgical complications were more common in weight loss patients (47 percent) than in control patients (25 percent). MMP analyses showed that MMP-9 levels remained significantly elevated at postoperative day 4 in patients who subsequently experienced complications in either the weight loss group (p = 0.02) or the control group (p = 0.03). Other parameters showed no significant differences between massive weight loss patients and controls. Conclusions: Although many markers were examined, the ratio of MMP-9 to albumin was the only predictor of postsurgical complications in any group. This lends further support to growing evidence that MMP-9 may be a useful biomarker of postsurgical complications. This pilot work showed no causal factors that explain the higher rates of postsurgical complications in the post-bariatric surgery patient population.Plastic & Reconstructive Surgery 10/2014; 134(4):530e-8e. DOI:10.1097/PRS.0000000000000520 · 3.33 Impact Factor