The Effects of Bariatric Surgery on the Cardiovascular System
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OBESITY AND DIET (G. RAO, SECTION EDITOR)
The Effects of Bariatric Surgery on the Cardiovascular System Keith Bernis 1 & Roberta Florido 1 & Chiadi E. Ndumele 1
Published online: 5 June 2017 # Springer Science+Business Media New York 2017
Abstract Purpose of Review Obesity, which has reached epidemic proportions in industrialized regions, is associated with myriad cardiovascular abnormalities and several different types of cardiovascular disease (CVD). However, the finding of an obesity paradox among patients with prevalent CVD and limited cardiovascular outcomes data from clinical trials of medical weight loss have raised questions regarding the cardiovascular benefits of weight loss, particularly among those with existing CVD. Therefore, in this manuscript, we review recent investigative developments regarding the effects of bariatric surgery on the cardiovascular system. Recent Findings Emerging evidence demonstrates several beneficial cardiovascular changes following bariatric surgery. The weight loss consequent to bariatric surgery is associated with improved vascular function, lessened atherosclerosis, reversals of cardiac remodeling, and improved surrogate measures of arrhythmia. Additionally, a growing body of prospective, nonrandomized data also demonstrates a reduction in hard cardiovascular endpoints, including coronary heart disease events, heart failure rates, and incident atrial fibrillation. Summary Surgical weight loss is linked to several improvements in cardiovascular structure and function, as well as a reduction in cardiovascular events. However, there is a need for
This article is part of Topical Collection on Obesity and Diet * Chiadi E. Ndumele [email protected] 1
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Carnegie 568, Baltimore, MD 21287, USA
additional data examining the effects of bariatric surgery on cardiovascular outcomes, particularly related to heart failure and arrhythmias and among patients with existing CVD. Despite the noted obesity paradox in CVD, it is likely that marked intentional weight loss among patients with morbid obesity is associated with significant cardiovascular risk reduction. Keywords Cardiovascular disease (CVD) . Obesity . Bariatric surgery . Medical weight loss
Introduction: Obesity and Cardiovascular Disease Obesity is a major worldwide cause of morbidity and premature mortality, with excess weight being linked to almost 3 million deaths globally [1]. Obesity has particularly profound effects on the cardiovascular system [2]. Greater blood volume and increased vascular resistance in the setting of obesity raises arterial pressure [3]. Obesity and ectopic fat accumulation, particularly in the visceral cavity and liver, also promote insulin resistance and associated hyperglycemia [4]. In turn, hyperinsulinemia and the secretion of triglyceride-rich lipoprotein particles from the liver also lead to abnormalities in circulating lipid levels, most commonly character
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