BACKGROUND

We applied the novel Predicting Risk of Cardiovascular Disease EVENTs equations to evaluate cardiovascular-kidney-metabolic (CKM) health and estimated cardiovascular disease (CVD) risk after bariatric surgery.

METHODS

Among 7804 patients (aged 20-79 years) undergoing bariatric surgery at Vanderbilt University Medical Center during 1999 to 2022, CVD risk factors from before surgery to 2 years after surgery were extracted from electronic health records. The 10- and 30-year risks of total CVD, atherosclerotic CVD, coronary heart disease, stroke, and heart failure (HF) were estimated for patients without CVD history at each time point (n=124-2910), using the social deprivation index-enhanced Predicting Risk of Cardiovascular Disease EVENTs equations. Paired tests or McNemar tests were used to compare pre- with postsurgery CKM health and CVD risk. Two-sample tests were used to compare CVD risk reduction between patient subgroups.

RESULTS

CKM health was significantly improved after surgery with lower systolic blood pressure, non-high-density lipoprotein cholesterol, and diabetes prevalence, and higher high-density lipoprotein and estimated glomerular filtration rate. The 10-year risks of total CVD and its subtypes decreased by 21.7% to 56.3% at 1 year after surgery and by 14.6% to 46.5% at 2 years after surgery, with the largest reduction observed for HF. Younger age, White race, >30% weight loss, and diabetes history were associated with greater HF risk reductions. Similar results were found for the 30-year CVD risk estimates.

CONCLUSIONS

Bariatric surgery significantly improves CKM health and reduces estimated CVD risk, particularly HF, by 47% to 56% within 1 to 2 years after surgery. HF risk reduction may vary by patient's demographics, weight loss, and disease history, which warrants further research.