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Bariatric Surgery and Cardiovascular Outcomes: A Systematic Review
Study Questions:
What is the impact of bariatric surgery on cardiovascular (CV) risk factors, and on cardiac structure and function?
Methods:
A systematic review was conducted of articles reporting CV risk factors or noninvasive imaging parameters for patients undergoing bariatric surgery, from January 1950 to June 2012. Variables included clinical characteristics, surgical procedures, weight loss, changes in CV risk factors, and cardiac structure and cardiac function postoperatively.
Results:
Seventy-three CV risk factor studies involving 19,543 subjects were included (mean age 42 years, 76% female). Baseline prevalence of hypertension, diabetes, and hyperlipidemia were 44%, 24%, and 44%, respectively. Mean follow-up was 57.8 months (range 3-176) and average excess weight loss was 54% (range 16-87%). Postoperative resolution/improvement of hypertension occurred in 63% of subjects, of diabetes in 73%, and of hyperlipidemia in 65%. Echocardiographic data from 713 subjects demonstrated statistically significant improvements in left ventricular mass, E/A ratio, and isovolumic relaxation time postoperatively.
Conclusions:
This systematic review highlights the benefits of bariatric surgery in reducing risk factors for CV disease, inducing regression of left ventricular hypertrophy, and improving diastolic function.
Perspective:
The results support the recent liberalization of criteria for bariatric surgery and the potential value of medical alternatives. The impact of bariatric surgical and drug treatment on CV events and morbidity and mortality needs to be monitored in a registry. This can be facilitated by the mandatory electronic medical records systems in development in the United States.
Keywords: Hypertrophy, Left Ventricular, Bariatric Surgery, Hyperlipidemias, Risk Factors, Hypertension, Diabetes Mellitus, Postoperative Period, Echocardiography
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