The Comparative Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on 10-Year and Lifetime Atherosclerotic Cardiovascular Disease Risk

Abstract

Background: Bariatric surgery reduces atherosclerotic cardiovascular disease (ASCVD) risk. However, the comparative effect of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on 10-year and lifetime ASCVD risk, as defined by the American College of Cardiology/American Heart Association (ACC/AHA), remains unknown. Methods: Using the ACC/AHA ASCVD risk estimator, 10-year and lifetime ASCVD risks were calculated before and 1 year after bariatric surgery for patients aged 40–78 who underwent RYGB or SG at an academic medical center in California between 2003 and 2015. Change in risk was calculated by taking the difference between 1-year and baseline risk. Statistical analyses included the Wilcoxon signed rank test, Mann-Whitney U test, Quade’s test, and multiple logistic regression. Results: There were 536 patients (mean age 52 ± 10 years, 20% male), of whom 438 underwent RYGB and 98 underwent SG. Patients undergoing RYGB were predominately female (82% vs 71%, p = 0.021) and had higher baseline BMIs (44.4 ± 8.4 vs 41.9 ± 8.0, p < 0.001) than patients undergoing SG. Compared with baseline, 10-year and lifetime ASCVD risks were significantly lower 1 year after surgery (aggregate of RYGB and SG, 4.2 ± 6.0% vs. 2.2 ± 3.5%, p < 0.001; 50 ± 11% vs. 39 ± 12%, p < 0.001, respectively). Patients who underwent RYGB had greater reductions in 10-year and lifetime ASCVD risks from baseline to 1 year after surgery than patients who underwent SG (1.7 ± 3.5% vs. 0.8 ± 2.4%, p < 0.001; 11 ± 23% vs. 0 ± 12%, p < 0.001, respectively). Conclusions: Although RYGB and SG significantly lower 10-year and lifetime cardiovascular disease risks by 1 year after surgery, patients who undergo RYGB may experience greater cardiovascular risk reduction relative to counterparts who undergo SG.