Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Atherosclerosis Reports
Published in: Current Atherosclerosis Reports 6/2012

01-12-2012 | Lipid and Metabolic Effects of Gastrointestinal Surgery (F Rubino, Section Editor)

Gastrointestinal Surgery: Cardiovascular Risk Reduction and Improved Long-Term Survival in Patients with Obesity and Diabetes

Authors: Ted D. Adams, Lance E. Davidson, Sheldon E. Litwin, Steven C. Hunt

Published in: Current Atherosclerosis Reports | Issue 6/2012

Login to get access

Abstract

Whereas the initial focus of bariatric surgery primarily focused on weight loss and was considered by many clinicians and the public as a cosmetic-driven procedure, this surgical therapy is now recognized as a successful approach to reducing cardiovascular disease risk and the only substantial and sustainable weight loss treatment for most severely obese patients. In addition, as a result of the multiple metabolic-related benefits associated with bariatric surgery, efforts to understand physiologic and biochemical mechanisms have led to a dramatic increase in scientific discovery. This review focuses on bariatric research conducted during the past two decades in relation to cardiovascular disease risk and the effects of this surgical therapy on diabetes. Cardiovascular and diabetes mortality and morbidity associated with bariatric surgery are reviewed. The opportunity for bariatric (and/or metabolic) surgery to provide a preventive strategy for cardiovascular disease and diabetes as well as treatment therapy is presented for clinical consideration.
Literature
1.
Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–31.
2.
Consortium LAoBSL, Flum DR, Belle SH, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.PubMedCrossRef
3.
O'Brien PE. Bariatric surgery: mechanisms, indications and outcomes. J Gastroenterol Hepatol. 2010;25(8):1358–65.PubMedCrossRef
4.
Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA. 2002;288(14):1758–61.PubMedCrossRef
5.
Sturm R. Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med. 2003;163(18):2146–8.PubMedCrossRef
6.
Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355(8):763–78.PubMedCrossRef
7.
Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293(15):1861–7.PubMedCrossRef
8.
McTigue K, Larson JC, Valoski A, et al. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA. 2006;296(1):79–86.PubMedCrossRef
9.
Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med. 2004;351(26):2694–703.PubMedCrossRef
10.
Yaari S, Goldbourt U. Voluntary and involuntary weight loss: associations with long term mortality in 9,228 middle-aged and elderly men. Am J Epidemiol. 1998;148(6):546–55.PubMedCrossRef
11.
Gregg EW, Gerzoff RB, Thompson TJ, Williamson DF. Intentional weight loss and death in overweight and obese U.S. adults 35 years of age and older. Ann Intern Med. 2003;138(5):383–9.PubMed
12.
13.
Pamuk ER, Williamson DF, Madans J, Serdula MK, Kleinman JC, Byers T. Weight loss and mortality in a national cohort of adults, 1971–1987. Am J Epidemiol. 1992;136(6):686–97.PubMed
14.
Peeters A, O'Brien PE, Laurie C, et al. Substantial intentional weight loss and mortality in the severely obese. Ann Surg. 2007;246(6):1028–33.PubMedCrossRef
15.
• Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61. Long-term mortality study for bariatric surgery compared to severely obese matched controls. Results include mortality findings related to CVD and diabetes. PubMedCrossRef
16.
• Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52. Long-term mortality study for bariatric surgery compared to severely obese matched controls. This represents the only prospective mortality study of long-term clinical outcomes. PubMedCrossRef
17.
MacDonald Jr KG, Long SD, Swanson MS, et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg. 1997;1(3):213–20.PubMedCrossRef
18.
Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199(4):543–51.PubMedCrossRef
19.
Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23.PubMedCrossRef
20.
Zhang W, Mason EE, Renquist KE, Zimmerman MB. Factors influencing survival following surgical treatment of obesity. Obes Surg. 2005;15(1):43–50.PubMedCrossRef
21.
Sowemimo OA, Yood SM, Courtney J, et al. Natural history of morbid obesity without surgical intervention. Surg Obes Relat Dis. 2007;3(1):73–7.PubMedCrossRef
22.
Omalu BI, Ives DG, Buhari AM, et al. Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004. Arch Surg. 2007;142(10):923–8. discussion 929.PubMedCrossRef
23.
Busetto L, Mirabelli D, Petroni ML, et al. Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls. Surg Obes Relat Dis. 2007;3(5):496–502. discussion 502.PubMedCrossRef
24.
Buchwald H, Williams SE, Matts JP, Nguyen PA, Boen JR. Overall mortality in the program on the surgical control of the hyperlipidemias. J Am Coll Surg. 2002;195(3):327–31.PubMedCrossRef
25.
Johnson RJ, Johnson BL, Blackhurst DW, et al. Bariatric surgery is associated with a reduced risk of mortality in morbidly obese patients with a history of major cardiovascular events. Am Surg. 2012;78(6):685–92.PubMed
26.
Plecka OM, Marsk R, Rasmussen F, Lagergren J, Naslund E. Morbidity and mortality before and after bariatric surgery for morbid obesity compared with the general population. Br J Surg. 2011;98(6):811–6.CrossRef
27.
Buchwald H, Varco RL, Matts JP, et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. Report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med. 1990;323(14):946–55.PubMedCrossRef
28.
Zhang W, Mason EE, Renquist KE, Zimmerman MB, Contributors IBSR. Factors influencing survival following surgical treatment of obesity. Obes Surg. 2005;15(1):43–50.PubMedCrossRef
29.
Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.PubMedCrossRef
30.
Omalu BI, Luckasevic T, Shakir AM, Rozin L, Wecht CH, Kuller LH. Postbariatric surgery deaths, which fall under the jurisdiction of the coroner. Am J Forensic Med Pathol. 2004;25(3):237–42.PubMedCrossRef
31.
Buchwald H, Varco RL, Boen JR, et al. Effective lipid modification by partial ileal bypass reduced long-term coronary heart disease mortality and morbidity: five-year posttrial follow-up report from the POSCH. Program on the Surgical Control of the Hyperlipidemias. Arch Intern Med. 1998;158(11):1253–61.PubMedCrossRef
32.
Mortality rates after 10.5 years for participants in the Multiple Risk Factor Intervention Trial. Findings related to a priori hypotheses of the trial. The Multiple Risk Factor Intervention Trial Research Group. JAMA. 1990;263(13):1795–1801.
33.
Buchwald H, Matts JP, Fitch LL, et al. Changes in sequential coronary arteriograms and subsequent coronary events. Surgical Control of the Hyperlipidemias (POSCH) Group. JAMA. 1992;268(11):1429–33.PubMedCrossRef
34.
Buchwald H, Campos CT, Matts JP, Fitch LL, Long JM, Varco RL. Women in the POSCH trial. Effects of aggressive cholesterol modification in women with coronary heart disease. The POSCH Group. Program on the Surgical Control of the Hyperlipidemias. Ann Surg. 1992;216(4):389–98.PubMedCrossRef
35.
Dixon JB, O'Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.PubMedCrossRef
36.
Dixon JB, Strauss BJ, Laurie C, O'Brien PE. Changes in body composition with weight loss: obese subjects randomized to surgical and medical programs. Obesity. 2007;15(5):1187–98.PubMedCrossRef
37.
Dunn JP, Abumrad NN, Breitman I, et al. Hepatic and peripheral insulin sensitivity and diabetes remission at 1 month after Roux-en-Y gastric bypass surgery in patients randomized to omentectomy. Diabetes Care. 2012;35(1):137–42.PubMedCrossRef
38.
Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.PubMedCrossRef
39.
Matts JP, Buchwald H, Fitch LL, et al. Program on the Surgical Control of the Hyperlipidemias (POSCH): patient entry characteristics. The POSCH Group. Control Clin Trials. 1991;12(2):314–39.PubMedCrossRef
40.
Matts JP, Buchwald H, Fitch LL, et al. Subgroup analyses of the major clinical endpoints in the Program on the Surgical Control of the Hyperlipidemias (POSCH): overall mortality, atherosclerotic coronary heart disease (ACHD) mortality, and ACHD mortality or myocardial infarction. J Clin Epidemiol. 1995;48(3):389–405.PubMedCrossRef
41.
• Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85. One of the first randomized controlled trial to show the benefits of diabetes remission following bariatric surgery in comparison to intense clinical therapy for the treatment of diabetes.PubMedCrossRef
42.
O'Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144(9):625–33.PubMed
43.
Shah M, Snell PG, Rao S, et al. High-volume exercise program in obese bariatric surgery patients: a randomized, controlled trial. Obesity. 2011;19(9):1826–34.PubMedCrossRef
44.
• Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76. One of the first randomized controlled trial to show the benefits of diabetes remission following bariatric surgery in comparison to intense clinical therapy for the treatment of diabetes.PubMedCrossRef
45.
Sovik TT, Aasheim ET, Taha O, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. [Summary for patients in Ann Intern Med. 2011 Sep 6;155(5):I21; PMID: 21893617]. Ann Intern Med. 2011;155(5):281–91.PubMed
46.
Tarnoff M, Rodriguez L, Escalona A, et al. Open label, prospective, randomized controlled trial of an endoscopic duodenal-jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery. Surg Endosc. 2009;23(3):650–6.PubMedCrossRef
47.
Adams TD, Pendleton RC, Strong MB, et al. Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severely obese. Obesity. 2010;18(1):121–30.PubMedCrossRef
48.
Batsis JA, Romero-Corral A, Collazo-Clavell ML, Sarr MG, Somers VK, Lopez-Jimenez F. Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc. 2008;83(8):897–907.PubMed
49.
Luaces M, Cachofeiro V, Garcia-Munoz-Najar A, et al. Anatomical and functional alterations of the heart in morbid obesity. Changes after bariatric surgery. Rev Esp Cardiol. 2012;65(1):14–21.PubMedCrossRef
50.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.PubMed
51.
Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32:Suppl-7.CrossRef
52.
• Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65. This manuscript provides long-term cardiovascular-related events following bariatric surgery. The results provide evidence for the prevention of CVD after weight loss surgery.PubMedCrossRef
53.
Rider OJ, Francis JM, Ali MK, et al. Beneficial cardiovascular effects of bariatric surgical and dietary weight loss in obesity. J Am Coll Cardiol. 2009;54(8):718–26.PubMedCrossRef
54.
Kaul A, Sharma J. Impact of bariatric surgery on comorbidities. Surg Clin N Am. 2011;91(6):1295–312.PubMedCrossRef
55.
•• Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet. 2012;379(9833):2300–11. Very thorough review of the types of bariatric surgery and their association with diabetes remission.PubMedCrossRef
56.
Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.PubMedCrossRef
57.
Colquitt, Jill L, Picot, et al. Surgery for obesity [Systematic Review]. Cochrane Database of Systematic Reviews 2009;(1).
58.
Kushner RF, Noble CA. Long-term outcome of bariatric surgery: an interim analysis. Mayo Clin Proc. 2006;81(10 Suppl):S46–51.
59.
Technology Evaluation Center. Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. Chicago: Blue Cross and Blue Shield Association; 2003.
60.
Cummings DE, Flum DR. Gastrointestinal surgery as a treatment for diabetes. JAMA. 2008;299(3):341–3.PubMedCrossRef
61.
Athyros VG, Tziomalos K, Karagiannis A, et al. Cardiovascular benefits of bariatric surgery in morbidly obese patients. Obes Rev. 2011;12(7):515–24.PubMedCrossRef
62.
•• Poirier P, Cornier MA, Mazzone T, et al. Bariatric surgery and cardiovascular risk factors: a scientific statement from the American Heart Association. Circulation. 2011;123(15):1683–701. This reference represents a very thorough and up-to-date review of bariatric surgery with particular reference to the relationship of cardiovascular risk and bariatric surgery. The paper represents the position statement by the American Heart Association.PubMedCrossRef
63.
Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.PubMedCrossRef
64.
Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367(8):695–704.PubMedCrossRef
65.
Adams TD, Avelar E, Cloward T, et al. Design and rationale of the Utah obesity study. A study to assess morbidity following gastric bypass surgery. Contemp Clin Trials. 2005;26(5):534–51.PubMedCrossRef
66.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322(22):1561–6.PubMedCrossRef
67.
Karason K, Wallentin I, Larsson B, Sjostrom L. Effects of obesity and weight loss on left ventricular mass and relative wall thickness: survey and intervention study. BMJ. 1997;315(7113):912–6.PubMedCrossRef
68.
Kardassis D, Bech-Hanssen O, Schonander M, Sjostrom L, Petzold M, Karason K. Impact of body composition, fat distribution and sustained weight loss on cardiac function in obesity. Int J Cardiol. 2012;159(2):128–33.PubMedCrossRef
69.
Owan T, Avelar E, Morley K, et al. Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study. J Am Coll Cardiol. 2011;57(6):732–9.PubMedCrossRef
70.
Kardassis D, Bech-Hanssen O, Schonander M, Sjostrom L, Karason K. The influence of body composition, fat distribution, and sustained weight loss on left ventricular mass and geometry in obesity. Obesity. 2012;20(3):605–11.PubMedCrossRef
71.
Hofso D, Nordstrand N, Johnson LK, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163(5):735–45.PubMedCrossRef
72.
Garza CA, Pellikka PA, Somers VK, et al. Structural and functional changes in left and right ventricles after major weight loss following bariatric surgery for morbid obesity. Am J Cardiol. 2010;105(4):550–6.PubMedCrossRef
73.
Hsuan CF, Huang CK, Lin JW, et al. The effect of surgical weight reduction on left ventricular structure and function in severe obesity. Obesity. 2010;18(6):1188–93.PubMedCrossRef
74.
Algahim MF, Lux TR, Leichman JG, et al. Progressive regression of left ventricular hypertrophy two years after bariatric surgery. Am J Med. 2010;123(6):549–55.PubMedCrossRef
75.
Zimmet P, Alberti KG. Surgery or medical therapy for obese patients with type 2 diabetes? N Engl J Med. 2012;366(17):1635–6.PubMedCrossRef
Metadata
Title
Gastrointestinal Surgery: Cardiovascular Risk Reduction and Improved Long-Term Survival in Patients with Obesity and Diabetes
Authors
Ted D. Adams
Lance E. Davidson
Sheldon E. Litwin
Steven C. Hunt
Publication date
01-12-2012
Publisher
Current Science Inc.
Published in
Current Atherosclerosis Reports / Issue 6/2012
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-012-0286-4

Other articles of this Issue 6/2012

Current Atherosclerosis Reports 6/2012 Go to the issue

Lipid and Metabolic Effects of Gastrointestinal Surgery (F Rubino, Section Editor)

Impact of Gastrointestinal Surgery on Cardiometabolic Risk

Nutrition (BV Howard, Section Editor)

Arsenic Exposure and Cardiovascular Disease:An Updated Systematic Review

Nutrition (BV Howard, Section Editor)

Dietary Carbohydrates for Diabetics

Lipid and Metabolic Effects of Gastrointestinal Surgery (F Rubino, Section Editor)

Mechanisms of Weight Loss, Diabetes Control and Changes in Food Choices After Gastrointestinal Surgery

Nutrition (BV Howard, Section Editor)

Unprocessed Red and Processed Meats and Risk of Coronary Artery Disease and Type 2 Diabetes – An Updated Review of the Evidence

Nutrition (BV Howard, Section Editor)

Cardiovascular Benefits of Dietary Fiber
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits