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Earlier bariatric surgery may improve CV outcomes.

CHICAGO -- Sooner may be better than later when it comes to the timing of bariatric surgery in patients with morbid obesity.

Of 828 patients with body mass index of at least 35 kg/m2 who underwent laparoscopic adjustable gastric banding performed by a single surgeon and were followed for up to 11 years (mean of 10 years), 423 were aged 45 years or younger, and 405 were over age 45 years at the time of surgery. A comparison of outcomes between the two age groups showed that older age at the time of surgery was an independent predictor of cardiovascular events (hazard ratio, 1.8), Maharaj Singh, Ph.D., a biostatistician at the Aurora Research Institute, Milwaukee, reported in a poster at the annual meeting of the American College of Cardiology.

Despite a similar reduction in body weight after gastric banding surgery, the older patients experienced more cardiovascular (CV) events: myocardial infarction occurred in 0.2% and 1.7% of patients in the younger and older age groups. Respectively, pulmonary embolism occurred in 0.7% and 4.3%; congestive heart failure occurred in 2.8% and 7.8%; and stroke occurred in 3.7% and 7.6%, Dr. Singh said.

"Although the older group had more comorbidities, these were accounted for by multivariate analysis and age over 45 years remained an independent predictor of poor cardiovascular outcomes," senior coauthor Dr. Arshad Jahangir, professor of medicine at the University of Wisconsin-Madison, said in an interview.

Other independent predictors of adverse cardiovascular outcomes in the study were sleep apnea (HR, 4), history of hypertension (HR, 1.9), and depression, (HR, 1.8), Dr. Jahangir said.

"Gender, race, and diabetes mellitus did not independently predict cardiovascular events," he said.

Weight loss after bariatric surgery has been shown to reduce the risk of adverse cardiovascular events, but it has remained unclear whether the reduction in risk varies based on age at the time of surgery, he said.

The current findings suggest that the effects of laparoscopic adjustable gastric banding-induced weight loss on cardiovascular outcomes are greater in patients who undergo the surgery at a younger age, he said, adding that the findings also "raise important questions about whether better control of sleep apnea, hypertension, and depression could help further reduce cardiovascular events in morbidly obese individuals undergoing bariatric surgery and should be addressed in a prospective study of these patients."

The authors reported having no disclosures.




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Author:Worcester, Sharon
Publication:Clinical Psychiatry News
Date:May 1, 2016
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