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Bariatric surgery and cardiovascular risk reduction.

DOI:10.1097/MOL.0000000000000076 Obesity is an ubiquitous epidemic affecting all age groups. Several health hazards are directly or indirectly linked to obesity resulting in premature death usually because of cardiovascular disease. Medical and behavioural approaches to weight loss may be ineffective in many individuals. Hence, bariatric surgical procedures are increasingly recommended because of their efficacy in reducing weight and its related complications. In a recent survey involving countries belonging to the ‘International Federation for the Surgery of Obesity and Metabolic Disorders’, there were approximately 340 770 bariatric procedures performed worldwide in 2011, the majority being performed in the USA [1]. Recently, there has been growing interest in the cardiovascular benefits of bariatric surgery. A recent systematic review and meta-analysis [2 && ] looking at the randomized controlled trials (RCTs) and observational studies (OBSs) carried out between 2003 and 2012 in adults has provided interesting data. A total of 164 studies on 11 different bariatric surgical procedures, which were further categorized into five groups were reported. The follow-up period was variable with almost 55% studies providing details of more than 2 years of follow-up. Females and whites were the predominant groups, 78.9 and 74.6% respectively, with a mean presurgical BMI of 45.6. Peri operative mortality, complication rates, re-operation rates, comorbidity outcome data and the yearly change in BMI for up to 5 years in the RCTs and OBSs were separately reported. A comparison of the differing surgical procedures was made. This meta-analysis gives a comprehensive and contemporary comparison of the efficacy and complication rates of the differing surgical procedures. The benefits of bariatric surgery over and above simple weight reduction were also studied. The changes in adipocyte metabolism and the modulation of adipokine secretion may play an important role in achieving cardiovascular benefits after bariatric surgery. Incremental increases in the production of the anti-inflammatory adipokine (adiponectin) [3,4] and a commensurate reduction in pro inflammatory adipokines (leptin, C-reactive protein) [5,6] have been reported post bariatric