Alessandro Mor1, Philip Omotosho, Alfonso Torquati. 1. Department of Surgery, Duke Center for Metabolic and Bariatric Surgery, Duke University, 407 Crutchfield Street, Durham, NC, 27704, USA.
Abstract
BACKGROUND: 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). METHODS: In a prospective cohort study, we evaluated preoperatively and at 12 months, 61 morbidly obese subjects with diabetes. Thirty underwent laparoscopic RYGB, and 31 received 1 year of DSE, consisting of educational sessions on diet, nutrition, and exercise. Groups were matched for gender, age, weight, blood pressure, and cholesterol and triglyceride levels. Strict gender-specific FRS was used to assess the cardiovascular risk. RESULTS: Excess weight-loss percentages (%EWL) were 55.6 ± 15.1 in the RYGB group and 1.2 ± 10.8 in the DSE group (P < 0.001). The two groups were matched for baseline FRS. RYGB patients experienced a significant decrease in all FRS, whereas control subjects did not show a significant decrease for the 10-year risk for CHD, CVD and death from CVD. The between-group differences for changes from baseline to 12 months in all FRS were significant. The 10-year risk reductions for CHD, MI, stroke, CVD, death from CHD, and death from CVD in the RYGB group relative to the DSE group were, respectively, 42, 48, 30, 39, 50, and 50%. No correlations between reduction in FRS and %EWL were found after RYGB. CONCLUSIONS: A significant improvement in the 10 year estimated cardiovascular risk is observed in patients undergoing RYGB, but not in those who were offered usual medical therapy plus DSE. However, the effects of RYGB on FRS are independent of weight loss.
BACKGROUND: 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). METHODS: In a prospective cohort study, we evaluated preoperatively and at 12 months, 61 morbidly obese subjects with diabetes. Thirty underwent laparoscopic RYGB, and 31 received 1 year of DSE, consisting of educational sessions on diet, nutrition, and exercise. Groups were matched for gender, age, weight, blood pressure, and cholesterol and triglyceride levels. Strict gender-specific FRS was used to assess the cardiovascular risk. RESULTS:Excess weight-loss percentages (%EWL) were 55.6 ± 15.1 in the RYGB group and 1.2 ± 10.8 in the DSE group (P < 0.001). The two groups were matched for baseline FRS. RYGB patients experienced a significant decrease in all FRS, whereas control subjects did not show a significant decrease for the 10-year risk for CHD, CVD and death from CVD. The between-group differences for changes from baseline to 12 months in all FRS were significant. The 10-year risk reductions for CHD, MI, stroke, CVD, death from CHD, and death from CVD in the RYGB group relative to the DSE group were, respectively, 42, 48, 30, 39, 50, and 50%. No correlations between reduction in FRS and %EWL were found after RYGB. CONCLUSIONS: A significant improvement in the 10 year estimated cardiovascular risk is observed in patients undergoing RYGB, but not in those who were offered usual medical therapy plus DSE. However, the effects of RYGB on FRS are independent of weight loss.
Authors: Ninh T Nguyen; Xuan-Mai T Nguyen; James B Wooldridge; Johnathan A Slone; John S Lane Journal: Surg Obes Relat Dis Date: 2010-02-21 Impact factor: 4.734
Authors: Stacy A Brethauer; Helen M Heneghan; Shai Eldar; Patrick Gatmaitan; Hazel Huang; Sangeeta Kashyap; Heather L Gornik; John P Kirwan; Philip R Schauer Journal: Surg Endosc Date: 2011-03-17 Impact factor: 4.584
Authors: David Arterburn; Daniel P Schauer; Ruth E Wise; Keith S Gersin; David R Fischer; Calvin A Selwyn; Anne Erisman; Joel Tsevat Journal: Obes Surg Date: 2008-08-13 Impact factor: 4.129
Authors: Ralph B D'Agostino; Ramachandran S Vasan; Michael J Pencina; Philip A Wolf; Mark Cobain; Joseph M Massaro; William B Kannel Journal: Circulation Date: 2008-01-22 Impact factor: 29.690
Authors: Hira Aftab; Hilde Risstad; Torgeir T Søvik; Tomm Bernklev; Stephen Hewitt; Jon A Kristinsson; Tom Mala Journal: Surg Obes Relat Dis Date: 2013-05-25 Impact factor: 4.734
Authors: Daniel Gero; Lucie Favre; Pierre Allemann; Pierre Fournier; Nicolas Demartines; Michel Suter Journal: Obes Surg Date: 2018-03 Impact factor: 4.129
Authors: Matilde Rubio-Almanza; Rosa Cámara-Gómez; David Hervás-Marín; José Luis Ponce-Marco; Juan Francisco Merino-Torres Journal: BMC Endocr Disord Date: 2018-11-28 Impact factor: 2.763