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Obesity Surgery

, Volume 29, Issue 10, pp 3111–3117 | Cite as

The Comparative Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on 10-Year and Lifetime Atherosclerotic Cardiovascular Disease Risk

  • Viraj Raygor
  • Luis Garcia
  • David J. Maron
  • John M. MortonEmail author
Original Contributions

Abstract

Background

Bariatric surgery reduces atherosclerotic cardiovascular disease (ASCVD) risk. However, the comparative effect of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on 10-year and lifetime ASCVD risk, as defined by the American College of Cardiology/American Heart Association (ACC/AHA), remains unknown.

Methods

Using the ACC/AHA ASCVD risk estimator, 10-year and lifetime ASCVD risks were calculated before and 1 year after bariatric surgery for patients aged 40–78 who underwent RYGB or SG at an academic medical center in California between 2003 and 2015. Change in risk was calculated by taking the difference between 1-year and baseline risk. Statistical analyses included the Wilcoxon signed rank test, Mann-Whitney U test, Quade’s test, and multiple logistic regression.

Results

There were 536 patients (mean age 52 ± 10 years, 20% male), of whom 438 underwent RYGB and 98 underwent SG. Patients undergoing RYGB were predominately female (82% vs 71%, p = 0.021) and had higher baseline BMIs (44.4 ± 8.4 vs 41.9 ± 8.0, p < 0.001) than patients undergoing SG. Compared with baseline, 10-year and lifetime ASCVD risks were significantly lower 1 year after surgery (aggregate of RYGB and SG, 4.2 ± 6.0% vs. 2.2 ± 3.5%, p < 0.001; 50 ± 11% vs. 39 ± 12%, p < 0.001, respectively). Patients who underwent RYGB had greater reductions in 10-year and lifetime ASCVD risks from baseline to 1 year after surgery than patients who underwent SG (1.7 ± 3.5% vs. 0.8 ± 2.4%, p < 0.001; 11 ± 23% vs. 0 ± 12%, p < 0.001, respectively).

Conclusions

Although RYGB and SG significantly lower 10-year and lifetime cardiovascular disease risks by 1 year after surgery, patients who undergo RYGB may experience greater cardiovascular risk reduction relative to counterparts who undergo SG.

Keywords

Cardiac Risk Bariatric surgery Sleeve gastrectomy Gastric bypass 

Notes

Authors’ Contribution

V.R. performed data analysis and wrote the manuscript. L.G. assisted with data analysis and reviewed the manuscript. D.M. contributed to the research design and revised the manuscript. J.M. provided the data and critical review of the manuscript. J.M. and D.M. conceived of study. All authors agree with the contents of this manuscript.

Compliance with Ethical Standards

Data were collected from patients who provided written informed consent, and approval for this study was provided by the Stanford University Institutional Review Board.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889–934.CrossRefGoogle Scholar
  2. 2.
    Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013;63:2960–84.Google Scholar
  3. 3.
    Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Circulation. 2013;63:2935–59.Google Scholar
  4. 4.
    Muntner P, Colantonio LD, Cushman M, et al. Validation of the atherosclerotic cardiovascular disease pooled cohort risk equations. JAMA. 2014;311(14):1406–15.CrossRefGoogle Scholar
  5. 5.
    Loprinzi PD, Addoh O. Predictive validity of the American College of Cardiology/American Heart Association pooled cohort equations in predicting all-cause and cardiovascular disease-specific mortality in a National Prospective Cohort Study of adults in the United States. Mayo Clin Proc. 2016;91(6):763–9.CrossRefGoogle Scholar
  6. 6.
    Jensen MD, Ryan DH, Apovian CM, et al. AHA/ACC/TOS guideline for the management of overweight and obesity in adults. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. 2014. 2013;129(25 suppl 2):S102–S38.Google Scholar
  7. 7.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefGoogle Scholar
  8. 8.
    DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356(21):2176–83.CrossRefGoogle Scholar
  9. 9.
    Ponce J, DeMaria EJ, Nguyen NT, et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis. 2016;12(9):1637–9.CrossRefGoogle Scholar
  10. 10.
    Li J-F, Lai D-D, Ni B, et al. Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Can J Surg. 2013;56(6):E158–E64.CrossRefGoogle Scholar
  11. 11.
    Yska J, van Roon EN, de Boer A, et al. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population-based cohort study in the United Kingdom. JAMA Surg. 2015;150(12):1126–33.CrossRefGoogle Scholar
  12. 12.
    Cho J-M, Kim HJ, Menzo EL, et al. Effect of sleeve gastrectomy on type 2 diabetes as an alternative treatment modality to Roux-en-Y gastric bypass: systemic review and meta-analysis. Surg Obes Relat Dis. 2015;11(6):1273–80.CrossRefGoogle Scholar
  13. 13.
    Nassour I, Almandoz JP, Adams-Huet B, et al. Metabolic syndrome remission after Roux-en-Y gastric bypass or sleeve gastrectomy. Diabetes Metab Syndr Obes. 2017;10:393–402.CrossRefGoogle Scholar
  14. 14.
    Spivak H, Sakran N, Dicker D, et al. Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis. Surg Obes Relat Dis. 2017;13(7):1189–94.CrossRefGoogle Scholar
  15. 15.
    Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016;151(11):1046–55.CrossRefGoogle Scholar
  16. 16.
    Peterli R, Wölnerhanssen B, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-y gastric bypass on weight loss in patients with morbid obesity: the sm-boss randomized clinical trial. JAMA. 2018;319(3):255–65.CrossRefGoogle Scholar
  17. 17.
    Salminen P, Helmiö M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-y gastric bypass on weight loss at 5 years among patients with morbid obesity: the sleevepass randomized clinical trial. JAMA. 2018;319(3):241–54.CrossRefGoogle Scholar
  18. 18.
    Olbers T, Lönroth H, Fagevik-Olsén M, et al. Laparoscopic gastric bypass: development of technique, respiratory function, and long-term outcome. Obes Surg. 2003;13(3):364–70.CrossRefGoogle Scholar
  19. 19.
    Rosenthal RJ. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.CrossRefGoogle Scholar
  20. 20.
    Pok E-H, Lee W-J. Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus. World J Gastroenterol: WJG. 2014;20(39):14315–28.CrossRefGoogle Scholar
  21. 21.
    Wilson PWF, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.CrossRefGoogle Scholar
  22. 22.
    Torquati A, Wright K, Melvin W, et al. Effect of gastric bypass operation on Framingham and actual risk of cardiovascular events in class II to III obesity. J Am Coll Surg. 2007;204(5):776–82.CrossRefGoogle Scholar
  23. 23.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefGoogle Scholar
  24. 24.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.CrossRefGoogle Scholar
  25. 25.
    Benaiges D, Goday A, Ramon JM, et al. Laparoscopic sleeve gastrectomy and laparoscopic gastric bypass are equally effective for reduction of cardiovascular risk in severely obese patients at one year of follow-up. Surg Obes Relat Dis. 2011;7(5):575–80.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineStanford University School of MedicineStanfordUSA
  2. 2.Department of SurgeryYale UniversityNew HavenUSA

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