Impact of medical versus surgical weight loss on cardiovascular outcomes.

Abstract

Obesity contributes to cardiovascular disease in two ways - directly, as an independent risk factor, and indirectly, through its contribution to comorbidities such as hypertension, diabetes, dyslipidemia. This cascade of multiplicative effects means that early management of obesity is instrumental in risk reduction and prevention of adverse cardiovascular outcomes. The amount and sustainability of weight loss has been extensively studied and stratified by medical versus surgical weight loss. Medical weight loss has historically been inferior by both parameters; however, new therapies targeting glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) receptors have demonstrated very promising results independently for both weight loss and cardiovascular disease. In this review, we compare cardiovascular outcomes between bariatric surgical approaches and novel GLP-1/GIP medications. We aim to answer the following question: In this era of new pharmacological weight loss options, does the method of weight loss-surgical or medical-impact cardiovascular risk mitigation, or is the key factor the maintenance of a healthier weight, regardless of the method?