David Gutierrez Blanco, MD, David Romero Funes, MD, Federico Perez Quirante, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida
INTRODUCTION: The atherosclerotic cardiovascular disease(ASCVD) risk is defined as coronary death or nonfatal myocardial infarction, or fatal / nonfatal stroke. This is a 10-year and lifetime predictor tool that considers not only myocardial disease but includes fatal and non-fatal strokes. This tool has not been used to assess absolute risk reduction after a bariatric surgery. Our goal in this study is to evaluate the impact of a bariatric surgery in the reduction of the ASCVD risk score.
METHODS: From our bariatric population, we retrospectively reviewed all bariatric surgeries between 2010 and 2014. Patients who met the criteria for calculating the ASCVD 10-year and/or lifetime score calculation were included. Data collected included baseline demographics, perioperative parameters and postoperative outcomes at 12 months.
RESULTS: From our 1129 bariatric patients, 245 (21.7%) patients met the criteria for the ASCVD risk score calculation. Laparoscopic sleeve gastrectomy(LSG) was the most prevalent surgery 64.89%(N=159) following by laparoscopic Roux-en-Y gastric bypass(LRYGB) 24.48% (N=60). Females composed 69.38%(N=170) of our population. The average age for female was 50.72±11.37 years and for male 54.89±10.9 years. The initial BMI was 42.46±6.94kg/m2 for females and 42.90kg/m2±6.6 for males. The percentage of estimated BMI loss (%EBMIL) at 1 year was 67.64% in females and 64% on males. The preoperative 10-year ASCVD score was significantly higher in males compared to females (17.28% ±13.83 vs. 7.52%±9.09). After 12 months follow-up, the absolute risk reduction in males was 5.42% and 2.77% in females(P<0.001). The preoperative and 12 months lifetime risk was also calculated. In the preoperative settings males had a 56.98%±14.85 lifetime risk, while females had a 39.93%± 9.82. A significant decrease was also noted in both genders, 16.26% absolute lifetime risk reduction in males and 6.35% in females(P<0.001). Absolute 10-year risk reduction was found to be significant in LSG and LRYGB(p<0.001), compared to revision procedures(P=0.37) and laparoscopic adjustable gastric banding(p=0.15). After 1 year follow-up, treatment for hypertension was discontinued in 26.5% of the patients(p<0.001) and the complete resolution of diabetes mellitus was achieved in 13% of the patients(p<0.001). Furthermore, other variables such as total cholesterol, systolic blood pressure, tobacco use and HDL showed to significant improve at 12 months follow-up.
CONCLUSION: Our results suggest that there is a positive correlation between bariatric surgery, especially LSG and LRYGB, and the reduction of the 10-year and lifetime cardiovascular disease risk. Further prospective studies may be needed to better understand this correlation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79309
Program Number: P526
Presentation Session: Poster (Non CME)
Presentation Type: Poster