Cardiometabolic Health and Bariatric Surgery: A 25-Year Longitudinal Cohort Study in CARDIA Participants

Abstract

Objective: Compare longitudinal cardiometabolic health outcomes among individuals who underwent bariatric surgery (BarS) with nonsurgical controls.

Background: BarS is well-established for inducing profound weight loss and improving cardiometabolic health, but it remains unclear whether patients achieve long-term cardiometabolic health consistent with the attained lower weight status.

Methods: Cohort study participants who underwent any BarS procedure between 1987 and 2021 (n = 94) were paired with sex- and body mass index (BMI)-matched nonsurgical controls (n = 282) at the nearest postoperative cohort exam visit (2.8 ± 1.7 years following surgery). A mixed model tested differences between BarS cases and nonsurgical matched controls, adjusting for age, sex, race, field center, and maximal education attainment. Intermediate cardiometabolic endpoints and incident diabetes and metabolic syndrome, were examined at follow-up exam visits.

Results: Approximately 7.5 years following their procedures, those who underwent BarS showed higher BMIs than matched controls (+2.8 kg/m²); however, the BarS group showed significantly lower mean fasting levels of glucose (-6.5 mg/dL; P = 0.03), insulin (-2.75 μU/mL; P = 0.01), low density lipoprotein cholesterol (-20.0 mg/dL; P < 0.001), C-reactive protein (log-transformed) (-0.42; P = 0.002), homeostasis model assessment-estimated insulin resistance (-0.75; P = 0.02), and higher mean high density lipoprotein cholesterol (+11.4 mg/dL; P < 0.001) compared to matched controls. BarS cases showed lower incidence of diabetes (1.8% vs 11.7%; P = 0.007) and nominally lower MetS (13.7% vs 22.3%; P = 0.23).

Conclusions: We found no evidence of lasting adverse cardiometabolic health consequences of severe obesity in a sample of cohort participants who underwent a BarS procedure. On average, BarS cases showed features of better cardiometabolic health than postoperative-matched nonsurgical controls who followed a more moderate trajectory of obesity.

Keywords: bariatric surgery; cardiometabolic risk factors; obesity.

FIGURE 1.

Unadjusted mean BMI (SE) across exam visits in BarS cases and nonsurgical controls.

FIGURE 2.

Mean levels (SE) of fasting glucose, insulin, HOMA-IR, and C-reactive protein among BarS and nonsurgical control groups at preoperative (T₀) and postoperative exam visits (T₁ and T₂). *P ≤ 0.05, **P ≤ 0.01, and ***P ≤ 0.001.

FIGURE 3.

Mean lipid levels (SE) among BarS cases and nonsurgical controls at preoperative (T₀) and postoperative exam visits (T₁ and T₂). *P ≤ 0.05, **P ≤ 0.01, and ***P ≤ 0.001.

FIGURE 4.

Blood pressure readings among BarS and nonsurgical control groups at preoperative (T₀) and postoperative exam visits (T₁ and T₂). *P ≤ 0.05 and **P ≤ 0.01.

FIGURE 5.

Diabetes and MetS incidence and remission among BarS cases and nonsurgical controls at postoperative exam visits (T₁) and (T₂). *P ≤ 0.05, **P ≤ 0.01, and ***P ≤ 0.001.