Abstract
Background
Carotid intima-media thickness (CIMT) is increasingly used as a prognostic indicator for early atherosclerosis and the development of cardiovascular disease. The objective of this study is to assess the exact effects of bariatric surgery on CIMT reduction in different age groups.
Methods
CIMT was measured just proximal to the bifurcation of the carotid artery in 166 patients with mean body mass index of 43.4 kg/m2 before and at 6 and 12 months after bariatric surgery. Preoperative CIMT and Framingham Risk Score (FRS) were compared to measurements at 6 and 12 months, postoperatively. Impact of age on CIMT change and cardiovascular risk reduction was analyzed.
Results
Median follow-up was 12 months; 12% were lost to follow-up. Mean CIMT values at 12 months after bariatric surgery were significantly lower compared to baseline (0.619 vs. 0.587 mm, p = 0.005 in women and 0.675 vs. 0.622 mm, p = 0.037 in men, respectively), and these effects were statistically significant in all age groups. The mean reduction of CIMT for patients < 50 years at 12 months was 0.043 mm (− 7.0%), while CIMT was reduced with 0.013 mm for patients ≥ 50 years (− 1.9%, p = 0.022). At 12 months after bariatric surgery, FRS had decreased with 52% in patients < 50 years as compared with 35% in patients ≥ 50 years (p = 0.025).
Conclusions
Bariatric surgery resulted in a significant CIMT decrease in patients with morbid obesity in all evaluated age categories. These beneficial effects of bariatric surgery were more pronounced in younger patients, while cardiovascular risk reduction by bariatric surgery appeared inferior in patients of 50 years and older.
Similar content being viewed by others
Change history
26 October 2017
Frederik H. W. Jonker and Vera A. A. van Houten contributed equally to this work.
References
Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes. 2013;37:889–91.
Kopelman PG. Obesity as a medical problem. Nature. 2000;404:635–43.
National Institutes of Health National Heart, Lung, and Blood Institute. Incidence and Prevalence: 2006 Chart Book on Cardiovascular and Lung Diseases. https://www.nhlbi.nih.gov/research/reports/2006-incidence-chart-book.
Scaglione R, Argano C, Di Chiara T, et al. Obesity and cardiovascular risk: the new public health problem of worldwide proportions. Expert Rev Cardiovasc Ther. 2004;2:203–12.
Alvarez-Cordero R. Treatment of clinically severe obesity, a public health problem: introduction. World J Surg. 1998;22:905–6.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.
Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65.
Bots ML, Grobbee DE. Intima media thickness as a surrogate marker for generalised atherosclerosis. Cardiovascular Drugs Ther. 2002;16:341–51.
Salonen JT, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993;87:Ii56–65.
Cobble M, Bale B. Carotid intima-media thickness: knowledge and application to everyday practice. Postgrad Med. 2010;122:10–8.
Hurst RT, Ng DW, Kendall C, et al. Clinical use of carotid intima-media thickness: review of the literature. J Am Soc Echocardiogr. 2007;20:907–14.
Sirbu A, Nicolae H, Martin S, et al. IGF-1 and insulin resistance are major determinants of common carotid artery thickness in morbidly obese young patients. Angiology. 2016 Mar;67:259–65.
Sturm W, Tschoner A, Engl J, et al. Effect of bariatric surgery on both functional and structural measures of premature atherosclerosis. Eur Heart J. 2009;30:2038–43.
Sarmento PL, Plavnik FL, Zanella MT, et al. Association of carotid intima-media thickness and cardiovascular risk factors in women pre- and post-bariatric surgery. Obes Surg. 2009;19:339–44.
Habib P, Scrocco JD, Terek M, et al. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol. 2009;104:1251–5.
Tschoner A, Sturm W, Gelsinger C, et al. Long-term effects of weight loss after bariatric surgery on functional and structural markers of atherosclerosis. Obesity. 2013;21:1960–5.
Marchesi F, Giacosa R, Reggiani V, et al. Morphological changes in the carotid artery intima after gastric bypass for morbid obesity. Obes Surg. 2017;27:357–63.
García G, Bunout D, Mella J, et al. Bariatric surgery decreases carotid intima-media thickness in obese subjects. Nutr Hosp. 2013;28:1102–8.
Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts. 2008;1:52–9.
Kwok CS, Pradhan A, Khan MA, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;173(1):20–8.
Huang Y, Li W, Dong L, et al. Effect of statin therapy on the progression of common carotid artery intima-media thickness: an updated systematic review and meta-analysis of randomized controlled trials. J Atheroscler Thromb. 2013;20:108–21.
Lloyd-Jones DM, Wilson PW, Larson MG, et al. Framingham risk score and prediction of lifetime risk for coronary heart disease. Am J Cardiol. 2004;94:20–4.
Livingston EH, Langert J. The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg. 2006;141:1115–21.
Sanni A, Perez S, Medbery R, et al. Postoperative complications in bariatric surgery using age and BMI stratification: a study using ACS-NSQIP data. Surg Endosc. 2014;28:3302–9.
Scozzari G, Passera R, Benvenga R, et al. Age as a long-term prognostic factor in bariatric surgery. Ann Surg. 2012;256:724–9.
Lynch J, Belgaumkar A. Bariatric surgery is effective and safe in patients over 55: a systematic review and meta-analysis. Obes Surg. 2012;22:1507–16.
Acknowledgements
The authors would like to acknowledge Bendix R. Slegtenhorst, Evelien van Lierop, Remco Dubbeling, and Louise Groenendijk.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Statement
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Consent Statement
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Jonker, F.H.W., van Houten, V.A.A., Wijngaarden, L.H. et al. Age-Related Effects of Bariatric Surgery on Early Atherosclerosis and Cardiovascular Risk Reduction. OBES SURG 28, 1040–1046 (2018). https://doi.org/10.1007/s11695-017-2962-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-017-2962-5