Early Impact of Bariatric Surgery on Type II Diabetes, Hypertension, and Hyperlipidemia: A Systematic Review, Meta-Analysis and Meta-Regression on 6,587 Patients

Ricci, Cristian; Gaeta, Maddalena; Rausa, Emanuele; Macchitella, Yuri; Bonavina, Luigi
April 2014
Obesity Surgery;Apr2014, Vol. 24 Issue 4, p522
Academic Journal
Background: This study aims to evaluate the 12-24-month impact of bariatric surgery on the foremost modifiable traditional risk factors of cardiovascular disease. Methods: A systematic review and meta-analysis of prospective interventional studies reporting the most commonly performed laparoscopic surgical procedures, i.e., Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and cardiovascular risk reduction after surgery. Results: The bibliographic research conducted independently by two authors yielded 18 records. When looking at RYGB and AGB separately, we observed a relevant heterogeneity ( I index ≥87 %) when BMI reduction was considered as the main outcome. When hypertension, type II diabetes, and hyperlipidemia risk reduction was estimated, a highly significant beneficial effect was found. The risk reduction was 0.33 [0.26; 0.42] for type II diabetes, 0.52 [0.42; 0.64] for hypertension, and 0.39[0.27; 0.56] for hyperlipidemia ( P < 0.0001 for all outcomes considered). When looking at surgical technique separately, a higher but not statistically significant risk reduction for all outcomes considered was found. Results from the meta-regression approach showed an inverse relation between cardiovascular risks and BMI reduction. Conclusions: The present study showed an overall reduction of cardiovascular risk after bariatric surgery. According to our analysis a BMI reduction of 5 after surgery corresponds to a type II diabetes reduction of 33 % (as reported by Peluso and Vanek (Nutr Clin Pract 22(1):22-28, ); SAS Institute Inc., (-2004)), a hypertension reduction of 27 % (as reported by Buchwald and Oien (Obes Surg 23(4):427-436, ); Valera-Mora et al. (Am J Clin Nutr 81(6):1292-1297, )), and a hyperlipidemia reduction of 20 %(as reported by Adams et al. (JAMA 308(11):1122-31, )); Alexandrides et al. (Obes Surg 17(2):176-184, ). In summary, our study showed that laparoscopic bariatric surgery is an effective therapeutic option to reduce the cardiovascular risk in severe obese patients.


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