Evaluation of Current Eligibility Criteria for Bariatric Surgery Bariatric surgery and long-term cardiovascular events. Improved memory function two years after bariatric surgery. Effects of bariatric surgery on mortality in Swedish obese subjects. Lifestyle changes followed by bariatric surgery lower inflammatory markers and the cardiovascular risk factors C3 and C4. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Cardiovascular risk in relation to body mass index and use of evidence-based preventive medications in patients with or at risk of atherothrombosis. Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial. Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life Increasing hematocrit reduces early posttransplant cardiovascular risk in diabetic transplant recipients1 The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population Bariatric Surgery versus Lifestyle Interventions for Morbid Obesity—Changes in Body Weight, Risk Factors and Comorbidities at 1 Year Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women. Gastric Bypass Surgery Is Followed by Lowered Blood Pressure and Increased Diuresis - Long Term Results from the Swedish Obese Subjects (SOS) Study Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. Gender effect on vascular inflammation following bariatric surgery. Risk factors for cardiovascular events and bleeding complications following non-cardiac surgery or procedure in patients with drug eluting stent placement Young obese women with polycystic ovary syndrome have evidence of early coronary atherosclerosis. Changes in total energy intake and macronutrient composition after bariatric surgery predict long-term weight outcome: findings from the Swedish Obese Subjects (SOS) study. Melanocortin-4 Receptor Mutations and Polymorphisms Do Not Affect Weight Loss after Bariatric Surgery Usefulness of brachial artery flow-mediated dilation to predict long-term cardiovascular events in subjects without heart disease.
OBJECTIVE Patients with a BMI < 35 kg/m2 and patients with a BMI between 35 and 40 kg/m2 without comorbidities are noneligible by current eligibility criteria for bariatric surgery .  We used Swedish obese subjects ( SOS ) to explore long-term outcomes in noneligible versus eligible patients . RESEARCH DESIGN AND METHODS The SOS study involved 2,010 obese patients who underwent bariatric surgery ( 68 % vertical-b and ed gastroplasty , 19 % b and ing , and 13 % gastric bypass ) and 2,037 contemporaneously matched obese controls receiving usual care .  At inclusion , the participant age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women . The effect of surgery was assessed in patients that do ( n = 3,814 ) and do not ( n = 233 ) meet current eligibility criteria . The date of analysis was 1 January 2012 . The follow-up time was up to 20 years , with a median of 10 years . RESULTS Cardiovascular risk factors were significantly improved both in noneligible and eligible individuals after 10 years of follow-up . Surgery reduced the diabetes incidence in both the noneligible ( adjusted hazard ratio 0.33 [ 95 % CI 0.13–0.82 ] , P = 0.017 ) and eligible ( 0.27 [ 0.22–0.33 ] , P < 0.001 ) groups . We could not detect a difference in the effect of surgery between the groups ( adjusted interaction P value = 0.713 ) . CONCLUSIONS Bariatric surgery drastically reduced the incidence of type 2 diabetes both in noneligible and eligible patients and improved cardiovascular risk factors in both groups . Our results show that strict BMI cutoffs are of limited use for bariatric surgery prioritization if the aim is to prevent diabetes and improve cardiovascular risk factors CONTEXT Obesity is a risk factor for cardiovascular events . Weight loss might protect against cardiovascular events , but solid evidence is lacking . OBJECTIVE To study the association between bariatric surgery , weight loss , and cardiovascular events . DESIGN , SETTING , AND PARTICIPANTS The Swedish Obese Subjects ( SOS ) study is an ongoing , nonr and omized , prospect i ve , controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care . Patients were recruited between September 1 , 1987 , and January 31 , 2001 . Date of analysis was December 31 , 2009 , with median follow-up of 14.7 years ( range , 0 - 20 years ) . Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women . Exclusion criteria were identical in surgery and control patients . Surgery patients underwent gastric bypass ( 13.2 % ) , b and ing ( 18.7 % ) , or vertical b and ed gastroplasty ( 68.1 % ) , and controls received usual care in the Swedish primary health care system . Physical and biochemical examinations and data base cross-checks were undertaken at preplanned intervals . MAIN OUTCOME MEASURES The primary end point of the SOS study ( total mortality ) was published in 2007 . Myocardial infa rct ion and stroke were predefined secondary end points , considered separately and combined . RESULTS Bariatric surgery was associated with a reduced number of cardiovascular deaths ( 28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group ; adjusted hazard ratio [ HR ] , 0.47 ; 95 % CI , 0.29 - 0.76 ; P = .002 ) . The number of total first time ( fatal or nonfatal ) cardiovascular events ( myocardial infa rct ion or stroke , whichever came first ) was lower in the surgery group ( 199 events among 2010 patients ) than in the control group ( 234 events among 2037 patients ; adjusted HR , 0.67 ; 95 % CI , 0.54 - 0.83 ; P < .001 ) . CONCLUSION Compared with usual care , bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults OBJECTIVE Obesity is as an independent risk factor for poor neurocognitive outcomes , including Alzheimer 's disease .  Bariatric surgery has recently been shown to result in improved memory at 12-weeks postoperatively . However , the long-term effects of bariatric surgery on cognitive function remain unclear . DESIGN AND METHODS Eighty-six individuals ( 63 bariatric surgery patients , 23 obese controls ) were recruited from a prospect i ve study examining the neurocognitive effects of bariatric surgery .  All participants completed  self-report measurements and a computerized cognitive test battery  prior to surgery and at 12-week and 24-month follow-up ; obese controls completed measures at equivalent time points . RESULTS Bariatric surgery patients exhibited high rates of pre-operative cognitive impairments in attention , executive function , memory , and language . Relative to obese controls , repeated measures ANOVA showed improvements in memory from baseline to 12-weeks and 24-months postoperatively ( P < 0.05 ) . Regression analyses controlling for baseline factors revealed that a lower BMI at 24-months demonstrated a trend toward significance for improved memory ( β = -.30 , P = 0.075 ) . CONCLUSION These findings suggest that cognitive benefits of bariatric surgery may extend to 24-months postoperatively . Larger prospect i ve studies with extended follow-up periods are needed to eluci date whether bariatric surgery decreases risk for cognitive decline and possibly the development of dementia BACKGROUND Obesity is associated with increased mortality . Weight loss improves cardiovascular risk factors , but no prospect i ve interventional studies have reported whether weight loss decreases overall mortality . In fact , many observational studies suggest that weight reduction is associated with increased mortality . METHODS The prospect i ve , controlled Swedish Obese Subjects study involved 4047 obese subjects . Of these subjects , 2010 underwent bariatric surgery ( surgery group ) and 2037 received conventional treatment ( matched control group ) .  We report on overall mortality during an average of 10.9 years of follow-up . At the time of the analysis ( November 1 , 2005 ) , vital status was known for all but three subjects ( follow-up rate , 99.9 % ) . RESULTS The average weight change in control subjects was less than + /-2 % during the period of up to 15 years during which weights were recorded . Maximum weight losses in the surgical subgroups were observed after 1 to 2 years : gastric bypass , 32 % ; vertical-b and ed gastroplasty , 25 % ; and b and ing , 20 % . After 10 years , the weight losses from baseline were stabilized at 25 % , 16 % , and 14 % , respectively . There were 129 deaths in the control group and 101 deaths in the surgery group . The unadjusted overall hazard ratio was 0.76 in the surgery group ( P=0.04 ) , as compared with the control group , and the hazard ratio adjusted for sex , age , and risk factors was 0.71 ( P=0.01 ) . The most common causes of death were myocardial infa rct ion ( control group , 25 subjects ; surgery group , 13 subjects ) and cancer ( control group , 47 ; surgery group , 29 ) . CONCLUSIONS Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality BACKGROUND Morbidly obese patients are at risk of developing insulin resistance and cardiovascular disease . Low- grade systemic inflammation is an important factor for this development . We evaluated the effect of bariatric surgery on markers of inflammation , coagulation and glucose metabolism . METHODS Ninety-seven morbidly obese patients and 17 lean subjects ( control group ) participated .  Anthropometric measurements  as well as  fasting blood sample s  were obtained at first admission , prior to surgery , and 1 year after surgery . RESULTS At admission , the morbidly obese group had significantly elevated levels of the complement components C3 and C4 compared to the lean control group ( P<0.0001 ) . Levels of C3 and C4 dropped significantly in the morbidly obese group over time ( P<0.0001 ) , and , 1 year after the operation , levels were comparable to those of the control group . The same changes were seen for markers of inflammation ( high-sensitivity C-reactive protein , tumor necrosis factor-α , interferon-γ , interleukin-1 receptor antagonist , IL-6 , and IL-13 ) , coagulation ( fibrinogen and plasminogen activator inhibitor-1 ) , and glucose metabolism ( leptin and insulin ) . There was a positive correlation between changes in C3 and body mass index , weight , coagulation parameters , inflammatory parameters , and leptin , respectively . CONCLUSIONS Bariatric surgery in morbidly obese patients  reduced weight effectively . Even more importantly , the increased levels of several risk factors associated with diabetes and cardiovascular co-morbidity normalized 1 year after surgery BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline BACKGROUND & AIMS Severe obesity is implicated in development of nonalcoholic fatty liver disease ( NAFLD ) . Bariatric surgery induces weight loss and increases survival time of obese patients , but little is known about its effects on liver damage . We performed a 5-year prospect i ve study to evaluate fibrosis and nonalcoholic steatosis ( NASH ) in severely obese patients after bariatric surgery .  METHODS  Bariatric surgery was performed on 381 patients . Clinical and biological data , along with liver biopsies , were collected before and at 1 and 5 years after surgery . RESULTS Five years after surgery , levels of fibrosis increased significantly , but 95.7 % of patients maintained a fibrosis score < or= F1 . The percentage of patients with steatosis decreased from 37.4 % before surgery to 16 % , the NAFLD score from 1.97 to 1 , ballooning from 0.2 to 0.1 . Inflammation remained unchanged . The percentage of patients with probable or definite NASH decreased significantly over 5 years , from 27.4 % to 14.2 % . The kinetics of insulin resistance ( IR ) paralleled that of steatosis and ballooning ; the greatest improvements occurred within the first year and were sustained 5 years later . Steatosis and ballooning occurred more frequently in patients with a refractory IR profile . In multivariate analysis , the refractory IR profile independently predicted the persistence of steatosis and ballooning 5 years later . CONCLUSIONS Five years after bariatric surgery for severe obesity , almost all patients had low levels of NAFLD , whereas fibrosis slightly increased . Steatosis and ballooning were closely linked to IR ; long-term effects could be predicted by early improvement in IR AIM Explore the relation between body mass index ( BMI ) and cardiovascular disease , and the influence of optimal medical therapy ( OMT ) on this relationship . METHODS AND RESULTS Patients from the REACH cohort , an international , prospect i ve cohort of patients with or at high risk of atherosclerosis with documentation of potential confounders , including treatments and risk factors , were followed up to 4 years ( n = 54 285 ) . Patients were categorized according to baseline BMI ( ranging from underweight to Grade III obesity ) . Optimal medical therapy was defined as the use of the four cardioprotective medication classes ( statins , ACE inhibitors/angiotensin II receptor blockers , β-blockers , and antiplatelet agents ) . The main outcomes were all-cause mortality , cardiovascular ( CV ) mortality , and CV events . In primary and secondary prevention , a reverse J-shaped curve best described the relationship between BMI categories and the incidence of the various outcomes . In secondary prevention , the highest adjusted risks were observed for underweight patients ( 1.97 , P < 0.01 , and 1.29 , P = 0.03 , for CV mortality and CV events ) and the lowest HRs were observed , respectively , in Grade II and Grade III obese patients ( 0.73 , P < 0.01 and 0.80 , P < 0.01 ) . The proportion of patients on OMT increased with BMI from 10.1 to 36 % ( P < 0.001 ) . The apparent CV protection conferred by obesity persisted in patients receiving OMT . CONCLUSION An obesity paradox was observed in both primary and secondary CV prevention patients . The intensity of use of evidence -based preventive medications does not account for the paradoxical CV protection associated with obesity . At extremes of BMI , further interventions beyond OMT may be needed to reduce CV risk BACKGROUND Asymptomatic hyperuricemia increases renal and cardiovascular ( CV ) risk  . We previously conducted a 2-year , single-blind , r and omized , controlled trial of allopurinol treatment that showed improved estimated glomerular filtration rate and reduced CV risk . STUDY DESIGN Post hoc analysis of a long-term follow-up after completion of the 2-year trial . SETTING & PARTICIPANTS 113 participants ( 57 in the allopurinol group and 56 in the control group ) initially followed up for 2 years and 107 participants followed up to 5 additional years . INTERVENTION Continuation of allopurinol treatment , 100mg/d , or st and ard treatment .  OUTCOME Renal event ( defined as starting dialysis therapy and /or doubling serum creatinine and /or ≥50 % decrease in estimated estimated glomerular filtration rate ) and CV events ( defined as myocardial infa rct ion , coronary revascularization or angina pectoris , congestive heart failure , cerebrovascular disease , and peripheral vascular disease ) . RESULTS During initial follow-up , there were 2 renal and 7 CV events in the allopurinol group compared with 6 renal and 15 CV events in the control group . In the long-term follow-up period , 12 of 56 participants taking allopurinol stopped treatment and 10 of 51 control participants received allopurinol . During long-term follow-up , an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event , respectively , and an additional 18 and 8 participants in the control group experienced a renal or CV event , respectively . Thus , during the initial and long-term follow-up ( median , 84 months ) , 9 patients in the allopurinol group had a renal event compared with 24 patients in the control group ( HR , 0.32 ; 95 % CI , 0.15 - 0.69 ; P=0.004 ; adjusted for age , sex , baseline kidney function , uric acid level , and renin-angiotensin-aldosterone system blockers ) . Overall , 16 patients treated with allopurinol experienced CV events compared with 23 in the control group ( HR , 0.43 ; 95 % CI , 0.21 - 0.88 ; P=0.02 ; adjusted for age , sex , and baseline kidney function ) . LIMITATIONS Small sample size , single center , not double blind , post hoc follow-up and analysis . CONCLUSIONS Long-term treatment with allopurinol may slow the rate of progression of kidney disease and reduce CV risk Outcome reporting in  bariatric surgery  needs a core outcome set ( COS ) , an agreed minimum set of outcomes reported in all studies of a particular condition . The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS . Outcomes reported in r and omized controlled trials ( RCTs ) and large non-r and omized studies identified by a systematic review were listed verbatim and categorized into domains , scrutinizing the frequency of outcome reporting and uniformity of definitions . Ninety studies ( 39 RCTs ) identified 1,088 separate outcomes , grouped into nine domains with most ( n = 920 , 85 % ) reported only once . The largest outcome domain was ' surgical complications ' , and overall , 42 % of outcomes corresponded to a theme of ' adverse events ' . Only a quarter of outcomes were defined , and where provided definitions , which were often contradictory . Percentage of excess weight loss was the main study outcome in 49 studies , but nearly 40 % of weight loss outcomes were heterogeneous , thus not comparable . Outcomes of diverse bariatric operations focus largely on adverse events . Reporting is inconsistent and ill-defined , limiting interpretation and comparison of published studies . Thus , we propose and are developing a COS for the surgical treatment of severe and complex obesity Background Obesity is an increasing disease worldwide . Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients .  Laparoscopic Roux-en-Y Gastric Bypass ( LRYGB ) is the gold st and ard surgical technique . Laparoscopic Sleeve Gastrectomy ( LSG ) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract . The aim of this study is to evaluate the efficiency of both techniques . Our hypothesis is that LSG has a similar percentage excess BMI loss ( % E BMI L ) after 5 years compared to LRYGB . Methods / Design The Sleeve Bypass Trial is a r and omized multicentre clinical trial : patients eligible for bariatric surgery are r and omized to either LSG or LRYGB . Patients with a body mass index ( BMI ) ≥ 40 kg/m2 or BMI 35 kg/m2 with obesity related comorbidity ( T2 DM , sleep apnoea , hypertension ) are eligible for r and omization . At r and omization patients are stratified for centre , sex , T2 DM and BMI ≥ 50 kg/m2 . A total number of 620 patients will be enrolled and equally ( 1:1 ) r and omized to both treatment arms . Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial . The primary endpoint is the 5-year weight loss ( % E BMI L ) of LSG and LRYGB . Secondary endpoints are resolution of obesity related comorbidity , complications , revision bariatric surgery and quality of life ( QOL ) defined in various question naires . Discussion Long-term % E BMI L between the two treatment strategies used to be in favour of LRYGB , but more recent results throughout the world show similar % E BMI L in both techniques . If weight loss is comparable , obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future . Trial registration Dutch Trial Register : NTR 4741 Background . Cardiovascular disease remains epidemic in transplant recipients , despite aggressive treatment of cardiovascular risk factors . Thus , novel risk factors could play a role in the genesis of cardiovascular events in this population . Methods . We evaluated the impact of early posttransplant anemia on cardiovascular events . We examined rolling average hematocrit values at 30-day intervals and determined the effect of increasing hematocrit on the risk for cardiovascular ( CV ) events in a single-center population of 404 type 1 diabetic end-stage renal disease patients who underwent either cadaveric kidney transplantation alone or simultaneous pancreas-kidney transplantation .  Results . Greater than 60 % of the individuals in the study cohort had hematocrit less than or equal to 30 % at least once during the first 30 days posttransplant . Forty-two individuals ( 10.4 % of the study population ) had at least one 30-day rolling hematocrit less than or equal to 30 % and a CV event ( myocardial infa rct ion , CV death , angina , congestive heart failure ) during the first 26 weeks of the posttransplant course . Increasing hematocrit ( > 30 % ) led to a reduction in the risk ratio ( RR ) for a CV event compared with hematocrit less than or equal to 30 % ( RR , 0.237 ; P = 0.015 ) . The association between anemia and CV events remained statistically significant in a multivariate analysis ( RR , 0.65 ; P = 0.022 ) that also included age and a history of pretransplant ischemic heart disease . Conclusions . These data suggest that anemia is an important risk factor for early posttransplant CV events in a high-risk population . Prospect i ve studies of anemia management therapy in this setting are warranted to determine whether this will reduce early posttransplant CV risk Our purpose was to assess the cost , quality of life impact , and the cost – utility of bariatric surgery in a managed care population . We studied 221 patients who underwent bariatric surgery between 2001 and 2005 . We analyzed medical cl aims data for all patients and survey data for 122 survey respondents ( 55 % response rate ) . Patients were generally middle-aged , female , and white . Sixty-four percent underwent open and 33 % underwent laparoscopic Roux-en-Y procedures .  One year after surgery , mean body mass index fell from 51 to 31 kg/m2 in women and from 59 to 35 kg/m2 in men with substantial improvements in comorbidities . Postsurgical mortality and morbidity were low . Total per member per month costs increased in the 6 months before bariatric surgery , were lower in the 12 months after bariatric surgery , but increased somewhat over the next 12 months . When presurgical quality of life was assessed prospect ively , average health utility scores improved by 0.14 one year after surgery . In analyses that took a lifetime time horizon , projected future costs based on age and obesity and discounted costs and health utilities at 3 % per year , the cost – utility ratio for bariatric surgery versus no surgery was approximately $ 1,400 per quality -adjusted life-year gained . In sensitivity analyses , bariatric surgery was more cost-effective in women , non-whites , more obese patients , and when performed laparoscopically . Although not cost-saving , bariatric surgery represents a very good value for money . Its long-term cost effectiveness appears to depend on the natural history and cost of late postsurgical complications and the natural history and cost of untreated morbid obesity Background Few studies have looked at non-surgical alternatives for morbid obese patients . This study aims to compare 1-year weight loss and changes in risk factors and comorbidities after bariatric surgery and three conservative treatments . Methods Patients with morbid obesity ( BMI > 40 or BMI > 35 kg/m2 plus comorbidities ) on waiting list for bariatric surgery  , were non-r and omly allocated to ( A ) bariatric surgery or to one of three conservative treatments ; ( B ) residential intermittent program ; ( C ) commercial weight loss camp and ( D ) hospital outpatient program . Body weight , risk factors and comorbidities were assessed at baseline and 1 year . Results Of 206 participants , 179 completed the study . All treatments result ed in significant weight loss , but bariatric surgery ( 40 ± 14 kg , 31 ± 9 % ) led to the largest weight loss ( P < 0.0001 ) . There were no differences in weight loss between B and C ( 22 ± 13 kg , 15 ± 8 % vs. 18 ± 12 kg , 13 ± 8 % ) , but these result ed in larger weight loss compared with D ( 7 ± 10 kg , 5 ± 8 % ) . There were no differences in changes in total or LDL cholesterol , triacylglycerols or glucose between groups ; however , the increase in HDL cholesterol was significantly larger in groups A and C. There were no differences in comorbidities resolution between groups A and B , C and D combined ( except hypertension , which was better in group A ) . Conclusion In conclusion , although bariatric surgery leads to a greater weight loss at 1 year compared with conservative treatment , in patients with morbid obesity , clinical significant weight loss and similar improvements in risk factors and comorbidities resolution can also be achieved with lifestyle interventions CONTEXT Individual contributions of obesity and physical fitness ( physical activity and functional capacity ) to risk of coronary heart disease in women remain unclear . OBJECTIVE To investigate the relationships of measures of obesity ( body mass index [ BMI ] , waist circumference , waist-hip ratio , and waist-height ratio ) and physical fitness ( self-reported Duke Activity Status Index [ DASI ] and Postmenopausal Estrogen-Progestin Intervention question naire [ PEPI-Q ] scores ) with coronary artery disease ( CAD ) risk factors , angiographic CAD , and adverse cardiovascular ( CV ) events in women evaluated for suspected myocardial ischemia . DESIGN , SETTING , AND PARTICIPANTS The National Heart , Lung , and Blood Institute-sponsored Women 's Ischemia Syndrome Evaluation ( WISE ) is a multicenter prospect i ve cohort study . From 1996 - 2000 , 936 women were enrolled at 4 US academic medical centers at the time of clinical ly indicated coronary angiography and then assessed ( mean follow-up , 3.9 [ SD , 1.8 ] years ) for adverse outcomes . MAIN OUTCOME MEASURES Prevalence of obstructive CAD ( any angiographic stenosis > or=50 % ) and incidence of adverse CV events ( all-cause death or hospitalization for nonfatal myocardial infa rct ion , stroke , congestive heart failure , unstable angina , or other vascular events ) during follow-up . RESULTS Of 906 women ( mean age , 58 [ SD , 12 ] years ) with complete data , 19 % were of nonwhite race , 76 % were overweight ( BMI > or=25 ) , 70 % had low functional capacity ( DASI scores < 25 , equivalent to < or=7 metabolic equivalents [ METs ] ) , and 39 % had obstructive CAD . During follow-up , 337 ( 38 % ) women had a first adverse event , 118 ( 13 % ) had a major adverse event , and 68 ( 8 % ) died . Overweight women were more likely than normal weight women to have CAD risk factors , but neither BMI nor abdominal obesity measures were significantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors ( P = .05 to.88 ) . Conversely , women with lower DASI scores were significantly more likely to have CAD risk factors and obstructive CAD ( 44 % vs 26 % , P<.001 ) at baseline , and each 1-MET increase in DASI score was independently associated with an 8 % ( hazard ratio , 0.92 ; 95 % confidence interval , 0.85 - 0.99 ; P = .02 ) decrease in risk of major adverse CV events during follow-up . CONCLUSIONS Among women undergoing coronary angiography for suspected ischemia , higher self-reported physical fitness scores were independently associated with fewer CAD risk factors , less angiographic CAD , and lower risk for adverse CV events . Measures of obesity were not independently associated with these outcomes Objective To compare two bariatric surgical principles with regard to effects on blood pressure and salt intake . Background In most patients bariatric surgery induces a sustained weight loss and a reduced cardiovascular risk profile but the long-term effect on blood pressure is uncertain . Methods Cohort study with data from the prospect i ve , controlled Swedish Obese Subjects ( SOS ) study involving 480 primary health care centres and 25 surgical departments in Sweden . Obese patients treated with non-surgical methods ( Controls , n = 1636 and n = 1132 at 2 y and 10 y follow up , respectively ) were compared to patients treated with gastric bypass ( GBP , n = 245 and n = 277 , respectively ) or purely restrictive procedures ( vertical b and ed gastroplasty or gastric b and ing ;  VBG/B , n = 1534 and n = 1064 , respectively ) . Results At long-term follow-up ( median 10 y ) GBP was associated with lowered systolic ( mean : −5.1 mm Hg ) and diastolic pressure ( −5.6 mmHg ) differing significantly from both VBG/B ( −1.5 and −2.1 mmHg , respectively ; p<0.001 ) and Controls ( + 1.2 and −3.8 mmHg , respectively ; p<0.01 ) . Diurnal urinary output was + 100 ml ( P<0.05 ) and + 170 ml ( P<0.001 ) higher in GBP subjects than in weight-loss matched VBG/B subjects at the 2 y and 10 y follow-ups , respectively . Urinary output was linearly associated with blood pressure only after GBP and these patients consumed approximately 1 g salt per day more at the follow-ups than did VBG/B ( P<0.01 ) . Conclusions The purely restrictive techniques VBG/B exerted a transient blood pressure lowering effect , whereas gastric bypass was associated with a sustained blood pressure reduction and an increased diuresis . The daily salt consumption was higher after gastric bypass than after restrictive bariatric surgery BACKGROUND ( Extreme ) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences . Bariatric surgery is an effective intervention for obesity , but approximately 20 to 30 % of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies . This study examines the added value of pre-operative cognitive behavioral therapy ( CBT ) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style . We hypothesize that pre-operative CBT will result in better weight loss maintenance , reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone . METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are r and omly assigned to the control or treatment condition . Patients in the treatment condition receive 10 sessions of CBT before surgery aim ed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery . Weight loss , eating behavior , eating disorders , depression , quality of life and psychological distress are assessed before and after treatment , as well as 1 , 3 , and 5 year following surgery Studies have shown that mortality was reduced by 31.6 % in patients that underwent bariatric surgery  compared with the non-operative control group . However , in most surgical series the majority of patients were women , and men had higher post-operative mortality rates and a higher postoperative morbidity , regardless of weight . Our primary end point was to study gender effects on vascular inflammation following bariatric surgery for weight loss . Methods . A prospect i ve study evaluated vascular inflammation in obese patients before and three months after bariatric surgery .  Markers of vascular inflammation were measured - before surgery and three months afterwards . Results . One hundred and two patients ( 73 women and 29 men , 40.5 ± 12.3 years old ) underwent bariatric surgery .  Correlation was found between BMI change and waist circumference change ( r = 0.658 , P<0.001 ) . Three months post-surgery , BMI was significantly decreased ( p<0.001 ) ( a decrease of 8.82 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 17.33 cm ) . ICAM-1 levels and hs-CRP levels were decreased ( both P = 0.0001 ) . Gender differences seem to be borderline significant with respect to the prevalence of type II diabetes mellitus ( men > women ; P = 0.05 ) and hypertension ( men > women ; P = 0.06 ) . In women , following bariatric surgery  , BMI was decreased ( p<0.001 ) ( a decrease of 9.25 ) , waist circumference was reduced ( p<0.001 ) ( a decrease of 18.8 cm ) . ICAM-1 levels were decreased ( p = 0.002 ) and hs-CRP levels were also decreased ( P = 0.0001 ) . In men , following bariatric surgery  , BMI was decreased ( p = 0.001 ) ( a decrease of 8.1 ) , waist circumference was reduced ( p<0.005 ) ( a decrease of 14.6 cm ) ; however , although ICAM-1 levels and hs-CRP levels were decreased the decreases were non-significant ( both P = 0.09 ) . Discussion . Our study examined gender effects of bariatric surgery  on vascular inflammation  . Bariatric surgery had no significant effect on biochemical inflammatory markers in male patients , while females undergoing the same kind of bariatric surgery for weight loss showed a significant decrease in these markers of inflammation . These results may explain the epidemiological data that described higher morbidity and mortality among obese men undergoing  bariatric operation for  weight loss .  This is the first study that has demonstrated a gender difference in the inflammatory responses that may affect clinical outcome , and cardiovascular morbidity and mortality Objectives Previous studies suggest an increased incidence of cardiovascular ( CV ) events after P2Y12 receptor blocker cessation . The aim of this study was to examine the effect of P2Y12 receptor blocker cessation and other risk factors on the risk of CV events and bleeding events  after non-cardiac surgery/procedure in patients with drug-eluting stents ( DES ) . Design Retrospective cohort study . Setting Single large healthcare system in the northeast of the USA . Patients All adult patients who had a coronary drug eluting stent ( DES ) placed between 2002 and 2007 in our institution . Interventions No r and omised intervention . The principal exposure was cessation of P2Y12 receptor blocker Methods This was a retrospective study of all adult patients who had a coronary DES placed between 2002 and 2007 in our institution . We considered all non-cardiac procedures up to 1 year after DES placement . Generalised estimating equations were used to identify the independent risk factors . Multiple imputations were used to replace missing values . Main outcome measures The outcomes were CV events including death from any cause and bleeding , occurring within 30 days after the procedure . Results From 2002 to 2007 , 6397 patients had DES , 873 ( 13.6 % ) had at least one non-cardiac procedure . A total of 3.6 % ( 33/927 ) of the admissions were complicated by at least one cardiovascular event and 6.9 % ( 55/795 ) were complicated by bleeding . Urgent procedure ( versus elective ) was the only independent risk factor for CV events ( OR=4.82 , 95 % CI 1.95 to 11.89 ) . Older age , diabetes , urgent procedures , orthopaedic and vascular surgery compared to unclassified surgery were independent risk factors for bleeding . Conclusions Non-cardiac procedures are common within 1 year after DES placement . Urgent nature of procedure is a risk factor for CV events and bleeding complications . Older age , diabetes , type of surgery , are risk factors associated only with bleeding events CONTEXT Polycystic ovary syndrome ( PCOS ) is associated with comorbidities that may contribute to increased risk of cardiovascular disease . PCOS is associated with increased risk of metabolic syndrome , dyslipidemia , and diabetes , but it remains unclear whether traditional cardiovascular ( CV ) risk factors can help predict coronary artery disease in this population . OBJECTIVE The objectives of the study were to detect early-onset sub clinical coronary atherosclerosis ( using coronary artery calcium as a marker ) in young women with PCOS , compared with age- and body mass index-matched controls , and to compare traditional CV risk factors and inflammatory markers in the two groups . DESIGN This was a prospect i ve case-control study . SETTING The study was conducted at a university hospital . SUBJECTS Twenty-four obese ( body mass index > or= 30 kg/m2 ) PCOS subjects and 24 obese controls participated . OUTCOME MEASURES Coronary artery calcium , inflammatory markers ( high-sensitivity C-reactive protein , IL-6 , TNFalpha , adiponectin , leptin ) , fasting blood tests ( glucose , lipids , insulin ) , and dual-energy x-ray absorptiometry scan for body fat distribution were measured . RESULTS Coronary artery calcium was detected in eight of 24 PCOS subjects ( 33 % ) and two of 24 controls ( 8 % ) ( odds ratio 5.5 , 95 % confidence interval 1.03 , 29.45 , P < 0.03 ) . Traditional CV risk factors did not differ significantly between the two groups , nor did markers of inflammation or adiposity , body fat distribution , or metabolic parameters with the exception of significantly lower quantitative insulin sensitivity check index ( marker for insulin resistance ) in the PCOS group ( P < 0.05 ) . CONCLUSIONS Young , obese women with PCOS have a high prevalence of early asymptomatic coronary atherosclerosis , compared with obese controls . This increased risk is independent of traditional CV risk factors and novel markers of inflammation . These findings underscore the need to screen and aggressively counsel and treat these women to prevent symptomatic CV disease Background : Approximately 20 - 30 % of obese patients do not achieve successful weight outcomes after bariatric surgery . Objective : We examined whether short-term changes ( ≤0.5 y postsurgery ) in energy intake and macronutrient composition after bariatric surgery could predict 10-y weight change . Design : Participants were recruited from the Swedish Obese Subjects ( SOS ) study , which was a matched ( nonr and omized ) prospect i ve trial that compared bariatric surgery with usual care for obese patients . A total of 2010 patients who underwent bariatric surgery were included in the study .  Physical examinations ( e.g. , weight ) and question naires ( e.g. , dietary question naire ) were completed before and 0.5 , 1 , 2 , 3 , 4 , 6 , 8 , and 10 y after surgery . For the main analytic strategy , a linear mixed model was implemented , which included repeated measures with a r and om intercept and an unstructured covariance matrix . Results : Short-term changes in energy intake ( P < 0.001 ) and in relative proportions of energy from carbohydrates ( P < 0.001 ) , fat ( P < 0.001 ) , and protein ( P < 0.05 ) were associated with 10-y weight change after bariatric surgery . At the 10-y follow-up , men and women with the largest reductions in energy intake had lost 7.3 % and 3.9 % more weight , respectively , compared with that of subjects with the smallest intake reductions ( P < 0.001 ) . Greater weight loss was achieved in men and women who favored protein and carbohydrates over fat and in subjects who favored protein over carbohydrates than in individuals who favored the opposite changes in macronutrient composition ( P < 0.05 ) . Conclusions : The level of energy restriction that is achieved at 0.5 y after bariatric surgery predicts long-term weight loss . Weight loss is also associated with a changing dietary macronutrient composition . This trial was registered at clinical trials.gov as NCT01479452 Bariatric surgery is the most effective long term weight-loss therapy for severe and morbidly obese patients . Melanocortin-4 Receptor ( MC4R ) mutations , the most frequent known cause of monogenic obesity , affect the regulation of energy homeostasis . The impact of such mutations on weight loss after bariatric surgery is still debated . The objective is to determine the impact of MC4R status on weight loss in obese subjects over one year after bariatric surgery . A total of 648 patients , who were referred to bariatric surgery in a single clinical nutrition department , were genotyped for their MC4R status . The following four groups were categorized : functional MC4R mutations , MC4R single nucleotide polymorphisms ( SNPs ) : Val103Ile ( V103L ) and Ile251Leu ( I251L ) , MC4R variant rs17782313 ( downstream of MC4R ) and MC4R SNP A-178C on the promoter . Each patient was matched with two r and omly paired controls without mutation . Matching factors were age , sex , baseline weight and type of surgery procedure ( Roux-en-Y gastric bypass and adjustable gastric b and ing ) . We compared weight loss between cases and controls at 3 , 6 and 12 months after surgery . Among 648 patients , we identified 9 carriers of functional MC4R mutations , 10 carriers of MC4R V103L and I251L SNPs , 7 carriers of the rs17792313 variant and 22 carriers of the A-178C SNP . Weight loss at 3 , 6 and 12 months did not differ between cases and controls , whatever the MC4R mutations . This is the first case-control study to show that MC4R mutations and polymorphisms do not affect weight loss and body composition over one year after bariatric surgery Endothelial dysfunction is considered an important prognostic factor in atherosclerosis . To determine the long-term association of brachial artery flow-mediated dilation ( FMD ) and adverse cardiovascular ( CV ) events in healthy subjects , we prospect ively assessed brachial FMD in 618 consecutive healthy subjects with no apparent heart disease , 387 men ( 63 % ) , and mean age 54 ± 11 years . After overnight fasting and discontinuation of all medications for ≥12 hours , FMD was assessed using high-resolution linear array ultrasound . Subjects were divided into 2 groups : FMD ≤11.3 % ( n = 309 ) and > 11.3 % ( n = 309 ) , where 11.3 % is the median FMD , and were comparable regarding CV risk factors , lipoproteins , fasting glucose , C-reactive protein , concomitant medications , and Framingham 10-year risk score . In a mean clinical follow-up of 4.6 ± 1.8 years , the composite CV events ( all-cause mortality , nonfatal myocardial infa rct ion , hospitalization for heart failure or angina pectoris , stroke , coronary artery bypass grafting , and percutaneous coronary interventions ) were significantly more common in subjects with FMD ≤11.3 % rather than > 11.3 % ( 15.2 % vs 1.2 % , p = 0.0001 , respectively ) . Univariate analysis demonstrated that the median FMD significantly predicted CV events ( odds ratio 2.78 , 95 % CI 1.35 to 5.71 , p < 0.001 ) . Multivariate analysis , controlling for traditional CV risk factors , demonstrated that median FMD was the best independent predictor of long-term CV adverse events ( odds ratio 2.93 , 95 % CI 1.28 to 6.68 , p < 0.001 ) . In conclusion , brachial artery median FMD independently predicts long-term adverse CV events in healthy subjects with no apparent heart disease in addition to those derived from traditional risk factor assessment
Using mean data from the validation study , the trend and directionality in risk was similar in the Roux-en-Y group .
In conclusion , bariatric surgery predicts long-term decreases in CV risk in obese patients
Obese patients have an increased prevalence of  cardiovascular ( CV ) risk factors , which improve with bariatric surgery , but whether bariatric surgery reduces long-term CV events remains ill defined .