Bariatric Surgery and Cardiovascular Risk Factors

Abstract

T he rate of obesity is rising logarithmically, especially in those with severe obesity (body mass index [BMI] 40 kg/m 2). Cardiologists, endocrinologists, internists, family practitioners, and most healthcare professionals are increasingly confronted with the severely obese patient and with postoperative bariatric patients because obesity is associated with significant morbidity and increased mortality. In addition, more adolescents these days are severely obese. Substantial long-term successes of lifestyle modifications and drug therapy have been disappointing in this population. The National Institutes of Health has suggested that surgical therapy be proposed to those patients with BMI 40 kg/m 2 or 35 kg/m 2 with serious obesity-related comorbidities such as systemic hyperten-sion, type 2 diabetes mellitus, and obstructive sleep apnea. When indicated, surgical intervention leads to significant improvements in decreasing excess weight and comorbidi-ties that can be maintained over time. These include diabetes mellitus, dyslipidemia, liver disease, systemic hypertension, obstructive sleep apnea, and cardiovascular dysfunction. Recent prospective, nonrandomized, observational , or case-control population studies have also shown bariatric surgery to prolong survival in the severely obese. Different types of bariatric procedures are being performed. Historically, operative mortality was between 0.1% and 2.0% with more recent data not exceeding 1%. Early complications include pulmonary embolus (0.5%), anastomotic leaks (1.0% to 2.5%), and bleeding (1.0%). Late complications include anastomotic stricture, anasto-motic ulcers, hernias, band slippage, and behavioral mal-adaptation. The number of bariatric operations being performed is increasing tremendously as a result of increasing medical need and the evolution of safer surgical techniques and guidelines. Currently, bariatric surgery should be reserved for patients who have severe obesity in whom efforts at medical therapy have failed and an acceptable operative risk is present.