Bariatric surgery can lead to significant cardiometabolic health improvements using a variety of measures, including blood pressure, cholesterol, glucose and hemoglobin A1C, according to a new study published in the Journal of the Endocrine Society.
Researchers analyzed the de-identified electronic health records of more than 7,800 people between the ages of 20 to 79 who underwent bariatric surgery during 1999-2022 at Vanderbilt University Medical Center.
Improvements were pronounced among younger, female or self-identified white people and those without coexisting medical conditions. Most of the surgical patients were female and white, although the cohort included a significant number of male patients and Black patients – both of which are populations underrepresented in past bariatric surgery research.
To capture the longer-term improvements, researchers looked at several cardiometabolic measures, including blood pressure, cholesterol, glucose and hemoglobin A1C, which is an average measure of glucose control over three months. The research team also measured remission rates of diabetes, hypertension and dyslipidemia (high cholesterol), as well as the estimated 10-year cardiovascular disease risk.
“Our study showed an estimated 35% reduction in predicted 10-year cardiovascular disease risk one year after surgery,” said study author Danxia Yu, PhD, associate professor of Medicine at VUMC. “Additionally, 30% to 50% of people in our study experienced remissions of diabetes, hypertension and high cholesterol. Individuals who were younger, female, self-identified as white and had no history of cardiometabolic diseases tended to see greater post-surgery cardiometabolic improvements.”
“This clearly shows bariatric surgery not only leads to significant weight loss but also can substantially improve multiple factors that contribute to better cardiovascular health.”
Study findings showed that older, male or Black patients showed less reduction in estimated 10-year cardiovascular disease risk and lower odds of diabetes, hypertension and dyslipidemia remission than younger, female or white patients. Patients with a history of diabetes, hypertension, dyslipidemia or cardiovascular disease showed less improvements than those without.
“Our findings may help better identify which patients may require extra health management after surgery,” said study author Lei Wang, MPhil.
The investigative team has been funded by the National Institutes of Health (NIH) to examine pre- to post-surgery changes in gut microbiome and microbial metabolites and the associations of microbiome and metabolites with cardiometabolic improvements after surgery. The goal is to identify novel microbial features that may improve metabolic surgery outcome prediction and may guide potential future microbiota-targeted interventions to help patients achieve better cardiometabolic health.
The group is also studying gut microbiota-related mechanisms that impact colorectal cancer risk after bariatric surgery with the hope that findings can lead to novel therapies to reduce the risk of colorectal cancer among individuals with morbid obesity.
In 2017-2018, over 40% of U.S. adults in the United States had obesity and 9% had severe obesity, according to Centers for Disease Control and Prevention (CDC) statistics. Bariatric surgery is one method shown to help people with severe obesity lose weight and improve their health substantially.
For this study, the investigators drew upon the robust electronic health records of a large group of bariatric surgery patients who received care through the Vanderbilt Surgical Weight Loss program. The collaborative, multidisciplinary research team includes representatives from epidemiology, surgery, biomedical informatics, and students from Vanderbilt University School of Medicine.
Other study authors include Xiao-Ou Shu, MD, PhD; You Chen, PhD; Brandon Williams, MD; Matthew Spann, MD; Charles Flynn, PhD; and Wayne English, MD, at VUMC; Michael O’Brien and Xinmeng Zhang at Vanderbilt University; and Vance Albaugh, MD, PhD, at Pennington Biomedical Research Center.
The study was supported by grant R01DK126721 from the NIH.