Cardiovascular Outcomes and Magnitude of Weight Loss after Bariatric Surgery: A Longitudinal Study

• Published in: Obesity (Silver Spring, Md.) Vol. 29; p. 70
• Main Authors: Moize, Violeta, Ibarzabal, Ainitze, De hollanda, Anna, Pane, Adriana, Ortega, Emilio, Flores, Lilliam, Tundidor, Diana, Andreu, Alba, Molero, Judit, Balibrea, Jose, Vidal, Josep, Jimenez, Amanda
• Format: Journal Article
• Language: English
• Published: Silver Spring Blackwell Publishing Ltd 01.12.2021
• Subjects: Gastrointestinal surgery; Longitudinal studies
• ISSN: 1930-7381; 1930-739X

Background: (1) To explore the relationship between the magnitude of weight loss after bariatric surgery (BS) and post-surgical major adverse cardiovascular outcomes (MACE) incidence, (2) To compare the performance of <50% excess weight loss (EWL), <20% total body weight loss (TBWL), and -1 standard deviation in percentage of alterable weight loss (-1SD%AWL) as insufficient weight loss (IWL) measures for its association with MACE.Whether the extent of weight loss achieved after BS modulates cardiovascular benefits has seldom been assessed. Several weight-loss thresholds have been commonly used to classify BS-patients as good or poor responders without demonstrating its clinical relevance. Methods: Longitudinal observational study including 1700 individuals who underwent BS in a single institution between Jan-2005 and Dec-2014. Cox proportional hazard models were used to assess the relationship between 1-year and 5-year weight change and the time to first post-surgical MACE. Results: During a mean follow-up of 10.2 ± 2.8 years, 86 participants (5.2%) experienced a first post-surgical MACE. Higher weight loss at one-year (HR: 0.77 (95%CI: 0.61-0.098)) and 5-year (HR: 0.63 (95%CI: 0.42-0.092)) was related to a lower incidence of MACE. All short-term criteria for defining IWL were similarly associated with MACE, but -1SD%AWL identified more subjects at risk. Five-year TBWL < 20% and 5-year -1SD-AWL% were significantly associated with a higher risk for cardiovascular (CV) events. TBWL < 20% identified more subjects at risk. Conclusions: The extent of weight loss is closely related to long-term MACE incidence. Patients who lost -1SD%AWL at 1-year or <20% TBWL at 5-year may be considered poor responders.