Bariatric surgery is known to have favorable effects on the components of metabolic syndrome, including glycemic status, dyslipidemia, and blood pressure. As more long-term data becomes available, the metabolic and survival benefits gleaned from obesity surgery become even more apparent. However, the ultimate results of these metabolic changes on end-organ complications are largely unknown. Survival benefit after bariatric surgery has only been shown in a few published prospective studies. Among all of the bariatric procedures used in appropriate candidates with metabolic syndrome and T2DM, Roux-en-Y gastric bypass (RYGB) is considered by some to be the ideal procedure because of its remarkable effects on excess weight and comorbidities.
Several validated risk models for predicting specific diseases, including cardiovascular disease (CVD), nephropathy, and retinopathy, have been tested in epidemiologic studies. Most studies assessing end-organ risk in bariatric patients have focused on CVD risk using the Framingham coronary heart disease (CHD) risk score. Study cohorts have consisted of general bariatric patients, not diabetic patients specifically, and the follow-up has been relatively short. For instance, Torquati et al. and Kligman et al. separately reported Farmingham CHD risk reductions of 50% and 52% at 1 year after RYGB, respectively. Benaiges et al. demonstrated a reduction of estimated CHD risk by 52% at 12 months after RYGB and by 39% after sleeve gastrectomy using the Farmingham score in his prospective cohort of 140 patients. The difference, however, did not achieve statistical significance, most likely due to the small sample size. In contrast to the results of surgical weight loss, a significant reduction in the Framingham risk score after medical weight loss has not been reported in some studies.
In this lecture, professor Ali Aminian explains the positive effect of bariatric surgery on the death rate of patients after a heart attack and a stroke.