Reduced Risk of Cardiovascular Diseases after Bariatric Surgery Based on the New PREVENT Equations

Lei Wang, Xinmeng Zhang, You Chen, Charles Robb Flynn, Wayne English, Jason Samuels, D. Brandon Williams, Matthew Spann, Vance L. Albaugh, Xiao Ou Shu, Danxia Yu
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Abstract

Background: We applied the novel Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations to evaluate cardiovascular-kidney-metabolic (CKM) health and estimated CVD risk, including heart failure (HF), after bariatric surgery. Methods: Among 7804 patients (20-79 years) undergoing bariatric surgery at Vanderbilt University Medical Center during 1999-2022, CVD risk factors at pre-surgery, 1-year, and 2-year post-surgery were extracted from electronic health records. The 10- and 30-year risks of total CVD, atherosclerotic CVD (ASCVD), coronary heart disease (CHD), stroke, and HF were estimated for patients without a history of CVD or its subtypes at each time point, using the social deprivation index-enhanced PREVENT equations. Paired t-tests or McNemar tests were used to compare pre- with post-surgery CKM health and CVD risk. Two-sample t-tests were used to compare CVD risk reduction between patient subgroups defined by age, sex, race, operation type, weight loss, and history of diabetes, hypertension, and dyslipidemia. Results: CKM health was significantly improved after surgery with lower systolic blood pressure, non-high-density-lipoprotein cholesterol (non-HDL), and diabetes prevalence, but higher HDL and estimated glomerular filtration rate (eGFR). The 10-year total CVD risk decreased from 6.51% at pre-surgery to 4.81% and 5.08% at 1- and 2-year post-surgery (relative reduction: 25.9% and 16.8%), respectively. Significant risk reductions were seen for all CVD subtypes (i.e., ASCVD, CHD, stroke, and HF), with the largest reduction for HF (relative reduction: 55.7% and 44.8% at 1- and 2-year post-surgery, respectively). Younger age, White race, >30% weight loss, diabetes history, and no dyslipidemia history were associated with greater HF risk reductions. Similar results were found for the 30-year risk estimates. Conclusions: Bariatric surgery significantly improves CKM health and reduces estimated CVD risk, particularly HF, by 45-56% within 1-2 years post-surgery. HF risk reduction may vary by patient's demographics, weight loss, and disease history, which warrants further research.
根据新的 PREVENT 公式降低减肥手术后患心血管疾病的风险
背景:我们采用新颖的心血管疾病风险预测方程(PREVENT)来评估减肥手术后的心血管-肾脏-代谢(CKM)健康状况,并估计包括心力衰竭(HF)在内的心血管疾病风险。方法从电子健康记录中提取了1999-2022年间在范德比尔特大学医学中心接受减肥手术的7804名患者(20-79岁)在手术前、手术后1年和2年的心血管疾病风险因素。使用社会贫困指数增强型 PREVENT 方程估算了无心血管疾病史或其亚型的患者在每个时间点的 10 年和 30 年总心血管疾病、动脉粥样硬化性心血管疾病(ASCVD)、冠心病(CHD)、中风和高血压风险。采用配对 t 检验或 McNemar 检验来比较手术前和手术后的 CKM 健康状况和心血管疾病风险。根据年龄、性别、种族、手术类型、体重减轻情况以及糖尿病、高血压和血脂异常病史,采用双样本 t 检验比较不同亚组患者的心血管疾病风险降低情况。结果术后CKM健康状况明显改善,收缩压、非高密度脂蛋白胆固醇(non-HDL)和糖尿病患病率降低,但高密度脂蛋白和估计肾小球滤过率(eGFR)升高。10年的心血管疾病总风险从手术前的6.51%降至手术后1年和2年的4.81%和5.08%(相对降幅:25.9%和16.8%)。所有心血管疾病亚型(即急性心血管疾病、冠心病、中风和高血压)的风险都有显著降低,其中高血压的风险降低幅度最大(相对降低率分别为 55.7% 和 44.8%):手术后 1 年和 2 年的相对降幅分别为 55.7% 和 44.8%)。年龄较小、白种人、体重减轻 30%、有糖尿病史和无血脂异常史与房颤风险降低幅度较大有关。对30年风险的估计也发现了类似的结果:减肥手术能明显改善CKM健康状况,并在术后1-2年内将心血管疾病(尤其是高血压)的估计风险降低45%-56%。心房颤动风险的降低可能因患者的人口统计学特征、体重减轻情况和疾病史而异,这值得进一步研究。
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