Association of Bariatric Surgery With Vascular Outcomes

Key Points Question Is bariatric surgical weight loss intervention for obesity associated with microvascular and macrovascular outcomes, and are they differentially associated with sex, race, and metabolic status? Findings In 307 individuals with obesity who were followed up after bariatric surgery, the procedure was associated with significant weight loss and improvement in both macrovascular and microvascular function across subgroups of sex, race, and traditional metabolic syndrome. Biomarker assessment using high-sensitivity C-reactive protein plasma levels of greater than 2 mg/dL identified individuals with seemingly metabolically healthy obesity and low-grade inflammation who also derived microvascular benefit from weight loss surgery. Meaning These findings suggest that the beneficial effects of weight loss surgery extend broadly across sex, race, and certain metabolically healthy subgroups.
This cohort study identifies variables associated with vascular remodeling after bariatric surgery and examines how sex, race, and metabolic status are associated with microvascular and macrovascular outcomes.
Importance Bariatric surgical weight loss is associated with reduced cardiovascular mortality; however, the mechanisms underlying this association are incompletely understood. Objectives To identify variables associated with vascular remodeling after bariatric surgery and to examine how sex, race, and metabolic status are associated with microvascular and macrovascular outcomes. Design, Setting, and Participants This population-based longitudinal cohort included 307 individuals who underwent bariatric surgery. Participants were enrolled in the bariatric weight loss program at Boston Medical Center, a large, multi-ethnic urban hospital, with presurgical and postsurgical assessments. Data were collected from December 11, 2001 to August 27, 2019. Data were analyzed in September 2019. Exposure Bariatric surgery. Main Outcomes and Measures Flow-mediated dilation (FMD) and reactive hyperemia (RH) (as measures of macrovascular and microvascular function, respectively) and clinical variables were measured preoperatively at baseline and at least once postoperatively within 12 months of the bariatric intervention. Results A total of 307 participants with obesity (mean [SD] age, 42 [12] years; 246 [80%] women; 199 [65%] White; mean [SD] body mass index, 46 [8]) were enrolled in this study. Bariatric surgery was associated with significant weight loss and improved macrovascular and microvascular function across subgroups of sex, race, and traditional metabolic syndrome (mean [SD] pre- vs postsurgery weight: 126 [25] kg vs 104 [25] kg; P