Reducing the 10-year risk of ischemic cardiovascular disease to receive early cardiovascular benefits from bariatric surgery for obesity in China

Abstract

Background: Cardiovascular risk due to obesity can be improved greatly by bariatric surgery. However, there is no research involving appropriate model for evaluating cardiovascular disease risk reduction in bariatric surgery for obesity in China. We selected the ischemic cardiovascular disease (ICVD) risk score that accurately predict cardiovascular risk in Chinese adults to evaluate the 10-year risk of ICVD and estimated early cardiovascular benefits of bariatric surgery in obese Chinese patients through its reduction.

Methods: From 2017 to 2019 we followed up 107 patients 6 months after surgery and measured the ICVD 10-year risk and other cardiovascular factors before and after surgery.

Results: There were significant reductions in the ICVD total score (p < 0.001) and ICVD 10-year risk (%) (p < 0.001) 6 months post-operation compared with baseline. Furthermore, we found significant reductions in body mass index (BMI), body adiposity index (BAI), low-density lipoprotein (LDL), small dense-low-density lipoprotein (sd-LDL) and triglycerides (TG) 6 months after surgery compared with pre-operation (all p < 0.05). The decrease in ICVD total score was correlated with excess BMI loss (%EBMIL), reduced BAI, reduced LDL, reduced sd-LDL and reduced TG respectively (all p < 0.05) at 6 months post-operation. Moreover, there were significant reductions in the ICVD total score in the male subgroup [3 (3, 5) vs. 2.5 (2, 4), p < 0.001] and female subgroup [3 (2, 4) vs. 2 (1, 3), p < 0.001] 6 months post-operation compared with baseline. At last there were also significant reductions in the ICVD total score in the diabetic subgroup [5 (4, 6) vs. 4 (3, 5), p < 0.001] and non-diabetic subgroup [2 (2,3) vs. 2 (1, 2), p < 0.001] 6 months post-operation compared with baseline.

Conclusions: Bariatric surgery could provide early cardiovascular benefits for patients with obesity in China by reducing the 10-year risk of ICVD. Both men and women with obesity achieved cardiovascular benefits according to bariatric surgery, so did diabetic and non-diabetic patients.

Keywords: China; bariatric surgery; early cardiovascular benefits; ischemic cardiovascular disease; obesity.

Figure 1

(A) Simplified evaluation sheet for estimating 10-year risk of ICVD incidence in men. (B) Simplified evaluation sheet for estimating 10-year risk of ICVD incidence in women. ICVD, ischemic cardiovascular disease; SBP, systolic blood pressure; BMI, body mass index; TC, total cholesterol.

Figure 2

(A) Decreases in ICVD total score 6 months post-operation compared with pre-operation; (B) Decreases in ICVD 10-year risk 6 months post-operation compared with pre-operation; (C) Improvements in TG, TC, LDL, sd-LDL and HDL 6 months post-operation compared with pre-operation. (D) Decreases in the OGTT 6 months post-operation compared with pre-operation. (E) Decreases in IRT 6 months post-operation compared with pre-operation. *p < 0.05, **p < 0.01, ***p < 0.001 post-operation vs. pre-operation ICVD, ischemic cardiovascular disease; TG, triglyceride; TC, total cholesterol; LDL, low-density lipoprotein; sd-LDL, small dense-low-density lipoprotein; HDL, high-density lipoprotein; OGTT, oral glucose tolerance test; IRT, insulin release test. N = 107, continuous variables were expressed as the means ± standard deviations or medians and interquartile ranges. The differences in ICVD total score and ICVD 10-year risk between pre-operative group and post-operative group were evaluated by Wilcoxon's signed rank test. The paired-sample t-test was used to compare pre- and post-operative levels of TC, HDL, LDL, sdLDL, TG, OGTT and IRT.

Figure 3

(A) Correlation of ΔICVD total score with %EBMIL; (B) Correlation of ΔICVD total score with ΔBAI; (C) Correlation of ΔICVD total score with ΔLDL; (D) Correlation of ΔICVD total score with Δsd-LDL; (E) Correlation of ΔICVD total score with ΔTG. Δvalues were obtained by subtracting the 6-month value from the pre-operative value; ICVD, ischemic cardiovascular disease; %EBMIL, percent excess body mass index loss; BAI, body adiposity index; LDL, low-density lipoprotein; sd-LDL, small dense-low-density lipoprotein; TG, triglyceride. N = 107, Spearman correlation analysis as a nonparametric measure was used to examine the relationships between ΔICVD total score and %EBMIL, ΔBAI, ΔLDL, Δsd-LDL, ΔTG.