Predictors of change in cardiovascular disease risk and events following gastric bypass: a 7-year prospective multi-center study

Objective To identify predictors of change in cardiovascular disease (CVD) risk and cardiovascular events following Roux-en-Y gastric bypass surgery (RYGB). Background Change in short-term (i.e. 10-year) and Lifetime CVD risk following RYGB has significant heterogeneity. Methods Between 2006-2009, 1625 adults without a history of CVD enrolled in a prospective cohort study and underwent RYGB at 1 of 10 U.S. hospitals. Participants were followed annually for a maximum of 7 years. Associations between pre-surgery characteristics (anthropometric, sociodemographic, physical and mental health, alcohol/drug use, eating behaviors) and 1) pre- to post-surgery change in 10 year and Lifetime Atherosclerotic CVD (ASCVD) risk scores, respectively, and 2) having a CVD event (nonfatal myocardial infarction, stroke, ischemic heart disease, congestive heart failure, angina, percutaneous coronary intervention, coronary artery bypass grafting or CVD-attributed death) as repeated measures (years 1-7) were evaluated. Results Pre-surgery factors independently associated with decreases in both 10-year and Lifetime risk scores 1-7 years post-RYGB were higher CVD risk score, female sex, higher household income, and normal kidney function. Additionally, Black race and having diabetes were independently associated with decreases in 10-year risk, while not having diabetes and a higher (better) composite mental health score were independently related to decreases in Lifetime risk. A lower (worse) pre-surgery composite physical health score was associated with a higher CVD event risk (RR=1.68, per 10 points). Conclusion This study identified multiple pre-surgery factors that characterize patients who may have more cardiovascular benefit from RYGB, and patients who might require additional support to improve their cardiovascular health.