What Factors Influence CVD Outcomes Following Adolescent Bariatric Surgery?
Adolescents who undergo metabolic and bariatric surgery often have a lowered risk for cardiovascular disease (CVD) following the procedure, according to a recent study. In particular, younger, female patients who lose more weight tend to experience the greatest benefit.
Adolescents with severe obesity often have numerous risk factors for CVD, and although bariatric surgery is known to improve their risk, no other known studies have reported the specific factors that may predict this improvement.
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In the Teen-Longitudinal Assessment of Bariatric Surgery study, the researchers evaluated data on 242 adolescents at 5 different centers who received either Roux-en-Y gastric bypass (n=161), vertical sleeve gastrectomy (n=67), or adjustable gastric banding (n=14). Mean patient age was 17 years, and median body mass index (BMI) at baseline was 51 kg/m2.
Specifically, the researchers assessed recipients of Roux-en-Y gastric bypass and vertical sleeve gastrectomy for predictors of change in CVD risk factors at 3 years post-surgery. The predictors that were examined included blood pressure (BP), lipids, glucose homeostasis, and inflammation.
Findings from the study revealed that, following surgery, increasing weight loss independently predicted normalization in dyslipidemia, elevated BP, hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein. Furthermore, younger participants at the time of surgery were more likely to experience resolution of dyslipidemia compared with older participants, and girls were more likely to see improvements in elevated BP compared with boys.
Notably, the researchers observed significant improvements in lipid and BP values over time even in participants without frank dyslipidemia or elevated BP at baseline.
“Numerous [CVD risk factors] improve among adolescents undergoing [metabolic and bariatric surgery],” the researchers concluded. “Increased weight loss, female sex, and younger age predict a higher probability of resolution of specific [CVD risk factors]. The elucidation of predictors of change in [CVD risk factors] may lead to refinements in patient selection and optimal timing of adolescent bariatric surgery designed to improve clinical outcomes.”
—Christina Vogt
Reference:
Michalsky MP, Inge TH, Jenkins TM, et al. Cardiovascular risk factors after adolescent bariatric surgery [Published online January 8, 2018]. Pediatrics. doi:10.1542/peds.2017-2485.