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CARDIOVASCULAR RISK REDUCTION IN A LARGE COHORT STUDY: COMPARATIVE OUTCOMES OF SLEEVE GASTRECTOMY, ROUX-EN-Y GASTRIC BYPASS, AND BILIOPANCREATIC DIVERSION SURGERIES
Wissam Ghusn
*1,2, Tala Abedalqader
2, Nour El Ghazal
2, Noura Jawhar
2, Donna Abboud
2, Simon J Laplante
2, Eric J. Vargas
2, Andres Acosta
2, Omar M. Ghanem
21Internal Medicine, Boston University, Boston, MA; 2Mayo Clinic Minnesota, Rochester, MN
Introduction: Metabolic and bariatric surgery (MBS), including Sleeve Gastrectomy (SG), Roux-en-Y Gastric Bypass (RYGB), and Biliopancreatic Diversion with Duodenal Switch (BPD-DS), represents a cornerstone intervention for managing obesity and associated comorbidities. In addition to achieving significant weight loss, MBS plays a crucial role in reducing cardiovascular disease morbidity and mortality, particularly through improvements in atherosclerotic cardiovascular disease (ASCVD) risk. Despite the robust cardiovascular benefits of MBS, there is a lack of comprehensive comparative studies evaluating ASCVD risk reductions across all major procedures. This study aims to analyze ASCVD risk changes in patients undergoing SG, RYGB, and BPD-DS, while also considering weight loss and clinical parameters.
Methods: This retrospective cohort study evaluated patients undergoing SG, RYGB, or BPD-DS, with data collected over a 1-year follow-up period. Key parameters, including baseline characteristics including age, sex, race, body mass index (BMI), and 1-year outcomes, including total body weight loss percentage (TBWL%), and ASCVD risk changes were analyzed. ASCVD 10-year and lifetime risk scores at baseline and 1 year were calculated using standard ASCVD risk equations, which incorporates age, sex, race, cholesterol levels, blood pressure, medication use, diabetic status, and smoking status. Statistical analyses included ANOVA to compare ASCVD risk reductions across the three procedures. Multivariate linear regression was performed to adjust for potential confounders such as age, sex, BMI, and baseline ASCVD risk, and TBWL% achieved, ensuring robust comparative analysis.
Results: A total of 607 patients were included (mean age of 47.0± 12.4 years, BMI of 48.1± 10.4 kg/m
2, 74.5% female;
Table 1). There was no significant difference in baseline ASCVD 10-year risk score. TBWL% at 1 year was greatest for BPD-DS (36.3 ± 8.9%), followed by RYGB (30.5± 8.9%) and SG (20.9 ± 8.8%) (p<0.001). At 1-year, significant differences in ASCVD lifetime risk change were observed: SG (-3.5± 10.2%), RYGB (-9.6± 11.7%), and BPD-DS (-9.9± 14.5%) (p<0.01;
Figure 1A). Similarly, BPD-DS demonstrated superior ASCVD 10-year risk reduction: SG (0.33± 3.3%), RYGB (-0.95± 2.0%), and BPD-DS (-1.58± 2.2%) (p<0.01;
Figure 1B). In a multivariate linear regression, controlling for baseline characteristics and weight loss achieved, there was no significant differences in cardiovascular risk improvement at 1 year.
Conclusion: This study is the first to comprehensively compare ASCVD risk reductions across SG, RYGB, and BPD-DS, highlighting significant differences in both 10-year and lifetime outcomes. Despite all MBS demonstrating significant cardiovascular risk reduction, BPD-DS achieved the greatest TBWL% and associated ASCVD risk reduction.
Table 1: Demographic and clinical parameters.
Figure 1: Lifetime (A) and 10-year (B) ASCVD risk change in patients undergoing SG, RYGB, and BPD-DS after 1-year of follow up.
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