Abstract 038: 30-year Risk of Cardiovascular Disease in Adolescents With Severe Obesity: Benefit of Bariatric Surgery (Teen-LABS)

Abstract

Severe obesity in youth is associated with accentuated risks of chronic health problems. However, quantifying risk of cardiovascular disease (CVD) events later in life is challenged by long latent periods between risk factor development and overt disease outcomes. A 30-year CVD event risk score has been developed in the Framingham Offspring cohort to address this problem. The 30-year CVD event risks were estimated for adolescents with severe obesity prior to and up to 5 years after undergoing bariatric surgery. We hypothesized that adolescents with severe obesity would be at high risk for full CVD events within 30-years and that bariatric surgery would reduce that risk. Adolescents (n=215; mean age pre-op = 17 years; mean body mass index (BMI) = 53 kg/m 2 ) from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) were used in this analysis. Data collected preoperatively and annually to 5 years were analyzed. A 30-year composite risk score (CVD event risk) was examined which included the following hard endpoints: coronary death, myocardial infarction, and stroke (fatal and nonfatal), coronary insufficiency, angina pectoralis, transient ischemic attack, intermittent claudication, and congestive heart failure. CVD event risk score requires the following risk factors for calculation: Sex, age, systolic blood pressure, antihypertensive treatment, smoking, diabetes mellitus, total cholesterol, high-density lipoprotein cholesterol, and BMI. Data are presented as mean (SD) with differences between time-points examined using linear mixed-models. Preoperatively, the likelihood of CVD events was 7.9 (6.7)%. Preoperatively, 52.6% of the cohort presented with >5% risk of CVD events, 22.3% with >10% risk of event, and 10.7% with >15% risk of event. At 1-year post-surgery a significant reduction in CVD events (7.9 [6.7]% to 4.0 [3.4]%, p<0.0001) was estimated. A reduction in proportion with >5% (52.6% to 22.1%), >10% (22.3% to 4.4%), and >15% (10.7% to 1.7%) risk of CVD events was observed. These predicted benefits for full CVD events were sustained at 2 years (4.0 [2.9]%), 3 years (4.2 [3.8]%), 4 years (4.3 [3.1]%), and 5 years (4.8 [3.8]%) post-surgery, with similar >5%, >10%, and >15% risks noted (p<0.0001 for all years versus baseline). These data suggest that prior to bariatric surgery, the risk of CVD event within 30-years is pronounced. However, following bariatric surgery, risk of hard endpoints is substantially reduced for up to 5 years following surgery.