Effects of Bariatric Surgery on Cardiovascular Function

Abstract

Epidemiological evidence suggests that obesity has become a global pandemic with significant implications to public health. First, it affects virtually all ages and socioeconomic groups; second, it has become a major contributor to the international burden of chronic illness, including diseases of the cardiovascular system. According to the World Health Organization, an estimated 1.6 billion adults globally were overweight (body mass index [BMI] >25 kg/m2) and at least 400 million were obese (BMI >30 kg/m2) in 2005. Statistical projections indicate that these figures will continue to rise, so that by 2015 ≈2.3 billion adults will be overweight and >700 million will be obese.1 Traditional treatments to achieve weight loss such as diet, lifestyle, and behavioral therapy have proven relatively ineffective in treating obesity and associated cardiovascular risk factors in the long term, especially when used in isolation, but have demonstrated some metabolic and cardiovascular benefits when they are used together as combination strategies.2 It is important to note that these treatments have been specifically ineffective on the morbidly obese subgroup of patients (BMI >40 kg/m2) and have led to development of operations in the form of “bariatric surgery” to treat obesity and its comorbidities. Surgery for the treatment of morbid obesity can be offered according to guidelines established by the National Institutes of Health (United States) and the National Institute for Clinical Excellence (United Kingdom). Herein, we explore the potential role of bariatric surgery in the treatment and prevention of obesity-related cardiac disease, examining the associations and potential pathophysiological mechanisms through which both obesity and cardiac disease can be modified by bariatric operations. The term bariatric surgery refers to all surgical procedures utilized to achieve reduction of excess weight. The most widely accepted indication for bariatric operations currently includes patients seen in a multidisciplinary specialist …