Bariatric surgery for teens with severe obesity leads to lower long-term CVD risk
Bariatric surgery can help adolescents with severe obesity reduce their long-term cardiovascular disease risk, according to findings published in Obesity.
“Adolescents with severe obesity, especially those who undergo bariatric surgery, are estimated to be at high risk for a major cardiovascular event before the age of 50. The risk is greatly reduced, by about 50%, following bariatric surgery, and this risk reduction is sustainable out to 5 years following surgery,” Justin R. Ryder, PhD, assistant professor of pediatrics in the Center for Pediatric Obesity Medicine and associate director of research at the University of Minnesota Medical School of the University of Minnesota in Minneapolis, told Healio. “The degree of reduction following bariatric surgery and the sustainability, despite some weight regain following surgery, were surprising. In addition, we conducted cost-effectiveness analysis demonstrating surgery, despite the upfront cost, to be very cost-effective.”
Ryder and colleagues used the Framingham Heart Study CVD event model to project CVD risk over 30 years for 247 adolescents with normal weight (mean age, 15.9 years; 59% girls), 54 adolescents with overweight (mean age, 16.8 years; 63% girls), 131 adolescents with obesity (mean age, 16.3 years; 56% girls), 302 adolescents with severe obesity (mean age, 16.4 years; 62% girls) and 215 adolescents with severe obesity who had bariatric surgery (mean age, 17 years; 75% girls). The researchers projected the risks before and after surgery. The risk model incorporated factors such as blood pressure, triglycerides and cholesterol, which were provided by data collected from the Teen-LABS study and at Cincinnati Children’s Hospital and the University of Minnesota.
The researchers projected more than 5% baseline CVD risk for 52.6% of those who went on to have bariatric surgery, 38.7% of those with severe obesity who did not go on to have bariatric surgery, 13% of those with obesity, 9.3% of those with overweight and 0.8% of those with normal weight.
The baseline 30-year CVD risk was 7.9% among all those who went on to have bariatric surgery, which outpaced those with severe obesity who would not have bariatric surgery (5.5%), obesity (3.9%), overweight (3.1%) and normal weight (1.8%) based on post hoc pairwise comparisons (P < .01 for all).
“This finding emphasizes the truly unique nature of adolescents who qualify for and elect to undergo metabolic and bariatric surgery, as they appear to harbor a very concerning CVD risk profile,” the researchers wrote. “These results support the position that more effective treatment options are needed in this group to mitigate this risk.”
The researchers found that 34.5% fewer participants who underwent bariatric surgery had more than 5% 30-year CVD risk at 1 year vs. baseline, while 17.9% fewer had more than 10% risk and 9% fewer had more than 15% risk. In addition, the estimated event rate (4.58% vs. 7.31%) and estimated death rate (0.44% vs. 0.7%) were lower for those who had bariatric surgery vs. those with severe obesity who did not have bariatric surgery.
“This work highlights the seriousness of cardiovascular disease risk among adolescents with obesity and the potential lifesaving nature of bariatric surgery early in life,” Ryder said. “Bariatric surgery should be considered for adolescents with severe obesity who qualify in order to reduce the long-term risks of cardiovascular disease. These data support that the procedure is cost-effective at reducing events and death.” – by Phil Neuffer
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Justin R. Ryder, PhD, can be reached at firstname.lastname@example.org.
Disclosure: Ryder reports he has received support from Boehringer Ingelheim Pharmaceuticals.