title: Prognostic role of flow-mediated dilation and cardiac risk factors in post-menopausal women. Laparoscopic Roux-en-Y Gastric Bypass and Its Early Effect on Blood Pressure Serum C-Reactive Protein and White Blood Cell Count in Morbidly Obese Surgical Patients Estimating the benefits of modifying risk factors of cardiovascular disease: a comparison of primary vs secondary prevention. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Laparoscopic Adjustable Gastric Banding: Weight Loss, Co-morbidities, Medication Usage and Quality of Life at One Year Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity: experience with 50 patients. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis. Evaluation of Gastric Bypass Patients 1 Year After Surgery: Changes in Quality of Life and Obesity-Related Conditions Effects of bariatric surgery on mortality in Swedish obese subjects. Subgroup analyses of the major clinical endpoints in the Program on the Surgical Control of the Hyperlipidemias (POSCH): overall mortality, atherosclerotic coronary heart disease (ACHD) mortality, and ACHD mortality or myocardial infarction. The Laparoscopic Adjustable Gastric Band (Lap-Band®): A Prospective Study of Medium-Term Effects on Weight, Health and Quality of Life The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity: 1-year follow-up. A Case-Controlled Matched-Pair Cohort Study of Laparoscopic Roux-en-Y Gastric Bypass and Lap-Band® Patients in a Single US Center with Three-Year Follow-up Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Three-Year Follow-up of a Prospective Randomized Trial Comparing Laparoscopic Versus Open Gastric Bypass Effect of Lap-Band®-Induced Weight Loss on Type 2 Diabetes Mellitus and Hypertension Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. Report of the Program on the Surgical Control of the Hyperlipidemias (POSCH) Change in Predicted 10-Year Cardiovascular Risk Following Laparoscopic Roux-en-Y Gastric Bypass Surgery The effect of surgical weight reduction on left ventricular structure and function in severe obesity. Effective lipid modification by partial ileal bypass reduced long-term coronary heart disease mortality and morbidity: five-year posttrial follow-up report from the POSCH. Program on the Surgical Control of the Hyperlipidemias. Improvement in comorbid illness after placement of the Swedish Adjustable Gastric Band. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Outcome analysis of laparoscopic Roux-en-Y gastric bypass for morbid obesity 
  
abstract: OBJECTIVES The aim of this study was to examine the association between brachial artery flow-mediated dilation ( FMD ) and cardiovascular events in a cohort of initially asymptomatic post-menopausal women , with adjustment for the presence of the major cardiovascular risk factors . BACKGROUND Conventional major cardiovascular risk factors ( cigarette smoking , hypercholesterolemia , hypertension , and diabetes ) fail to explain nearly 50 % of cardiovascular events . Defining the magnitude of future risk for the development of clinical events is a major focus of effective primary prevention . Evaluation of endothelial function , utilizing the noninvasive measurement of the brachial artery FMD , may serve as a screening tool to individualize high-risk patients . METHODS We conducted a prospect i ve study on 2,264 post-menopausal women , age 54 + /- 6 years . The length of the follow-up was 45 + /- 13 months ( range 6 to 65 months ) . RESULTS During observation , 90 major events were recorded . Risk-adjusted relative risk values result ed 1.0 , 1.33 ( 95 % confidence interval [ CI ] 1.09 to 4.09 ) , and 4.42 ( 95 % CI 2.97 to 8.01 ) for women in the higher , intermediate , and lower tertile of FMD , respectively ( p < 0.0001 for trend ) . The event rate for women in the lower tertile ( FMD < or=4.5 % ) was greater than the combined event rate noted in the other 2 tertiles ( women in the lower tertile accounted for 51 events [ 56.6 % of total events ] ) . When added to age and other conventional cardiovascular risk factors ( smoking habits , presence of hypercholesterolemia , history of diabetes , hypertension ) , FMD contributed significantly to the model predicting cardiovascular events ( likelihood ratio chi-square change : 10.22 ; p < 0.0001 ) . CONCLUSIONS In post-menopausal women , the knowledge of FMD provided incremental prognostic information regarding the risk of developing cardiovascular events Background  Laparoscopic Roux-en-Y gastric bypass ( LRYGB ) surgery  is known to have a significant effect on obesity-related comorbidities such as hypertension curing it in some ( 50–70 % ) while improving control in others . Our aim was to observe the changes in blood pressure ( BP ) in a cohort of 100 patients followed prospect ively for 1 year after LRYGB .  Methods BP measurements were recorded prospect ively in 100 consecutive patients preoperatively and then postoperatively at weeks 1 , 5 , 9 , and months 6 and 12 . In order to reduce bias , three BP measurements were made by the same nurse at each office visit and the mean recorded . Pre- and postoperative usage of antihypertensive medication was also noted . Results Eighty-nine women and 11 men underwent LRYGB and their BP monitored for 1 year . There was an 85 % follow-up rate with mean % excess body weight loss of 60 . Reductions in systolic ( 9 mmHg ) and diastolic ( 7 mmHg ) BP measurements were seen as early as week 1 postoperatively and maintained for the duration of the observation period ( P < 0.05 ) . Furthermore , postoperative usage of antihypertensive medication is reduced to a third of preoperative use . Conclusion  LRYGB  is associated with an early reduction in BP and antihypertensive medication usage which is maintained at 1 year after surgery . This early impact on blood pressure occurs before any significant weight loss is achieved thereby suggesting a hormonal mechanism that may be involved for the changes observed Background Obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including C-reactive protein ( CRP ) and white blood cell count ( WBC ) . Recent studies have shown elevated CRP or WBC is a significant risk factor for cardiac events and stroke but the clinical significance of CRP and WBC has not been clearly studied in morbidly obese patients . This study is aim ed at the clinical significance of WBC and CRP in morbidly obese patients and the change after bariatric surgery . Methods The study was a prospect ively controlled clinical study . From December 1 , 2001 to January 31 , 2006 , of 640 ( 442 females and 198 males ) consecutive morbid obese patients enrolled in a surgically supervised weight loss program with at least 1 year ’s follow-up were examined . Results Of the patients , 476 ( 74.4 % ) had elevated CRP and 100 ( 15.6 % ) had elevated WBC at preoperative study .  CRP and WBC were significantly related and both increased with increasing body mass index ( BMI ) . CRP is also increased with increasing waist , glucose level , hemoglobin , albumin , Ca , insulin , C-peptide , and metabolic syndrome while WBC is increased with metabolic syndrome but decreased with increasing age . Multivariate analysis confirmed fasting glucose level and hemoglobin are independent predictors of the elevation of CRP while age is the only independent predictor for elevated WBC . Both WBC and CRP levels decreased rapidly after obesity surgery . These improvements result ed in a 69.8 % reduction of CRP and 26.4 % reduction of WBC 1 year after surgery . Although individuals who underwent laparoscopic gastric bypass lost significantly more weight ( 36.8 ± 11.7 kg vs. 17.3 ± 10.8 kg ; p = 0.000 ) and achieved a lower BMI ( 27.8 ± 4.6 vs. 35.0 ± 5.5 ; p = 0.000 ) than individuals who underwent laparoscopic gastric b and ing , there was no difference in the resolution of elevated CRP 1 year after surgery ( 95.9 % vs. 84.5 % ; p = 0.169 ) and WBC ( 99.4 % vs. 98.3 % ; p = 0.323 ) . Conclusions Both baseline WBC and CRP are elevated in morbid obese patients but CRP has a better clinical significance . Significant weight reduction 1 year after surgery markedly reduced CRP and WBC with a resolution rate of 93.9 % and 98.2 % separately . Obesity surgery performed by laparoscopic surgery is recommended for obese patients with elevated CRP or WBC OBJECTIVES To compare the potential years of life saved ( YOLS ) associated with risk factor modification in the primary and secondary prevention of cardiovascular disease ( CVD ) . METHODS The CVD life expectancy model estimates the risk of death due to coronary disease , stroke , and other causes based on the levels of independent risk factors ( such as age , blood pressure , and blood lipid levels ) found in the cohort of the Lipid Research Clinics . The model was vali date d by comparing its predictions with the observed fatal outcomes of 9 r and omized clinical trials . We then estimated the YOLS associated with treating hyperlipidemia or hypertension among hypothetical patient groups with and without CVD at baseline . We defined high-risk patients as those with 3 risk factors ( hyperlipidemia , cigarette smoking , and hypertension ) and low-risk patients as those with isolated hypertension or hyperlipidemia . RESULTS The fatal events predicted by the model were consistent with the clinical trial results . Among men and women with hyperlipidemia without CVD , the forecasted benefits of lipid therapy  were substantially greater among high-risk groups vs low-risk groups ( 4.74 - 0.78 YOLS vs 2.50 - 0.25 YOLS , respectively ) . Among those with CVD , the forecasted benefits of treatment were similar for both high-risk and low-risk groups ( 4.65 - 0.65 YOLS vs 3.84 - 0.58 YOLS , respectively ) . The results for  hypertension  therapy also demonstrated greater benefits for high-risk vs low-risk patients undergoing primary prevention therapy ( 1.34 - 0.29 YOLS vs 0.85 - 0.13 YOLS , respectively ) , and the forecasted benefits in secondary prevention were similar ( 1.26 - 0.23 YOLS vs 1.00 - 0.23 YOLS , respectively ) . CONCLUSIONS The clinical approach to risk factor modification in primary prevention should be different from that in secondary prevention . The forecasted benefits of therapy among patients without CVD are greatest in the presence of other risk factors . Among those with CVD , the benefits of therapy are equivalent , thereby obviating the need to target high-risk patients This study was design ed to assess the effects of bariatric weight loss surgery on structural , functional , and inflammatory markers of coronary atherosclerosis . Obesity is a worldwide epidemic and an independent risk factor for coronary atherosclerosis . It remains unclear whether surgically induced weight loss reduces cardiovascular risk . This prospect i ve study enrolled 50 consecutive subjects with morbid obesity who underwent Roux-en-Y gastric bypass surgery ( GBS ) after failed attempts at medical weight loss . Subjects were recruited through a comprehensive weight loss center affiliated with an academic tertiary care hospital . All subjects had body mass indexes > or = 40 kg/m(2 ) or body mass indexes of 35 to 40 kg/m(2 ) with > or = 2 co-morbid obesity-related conditions . Markers of coronary atherosclerosis , including brachial artery flow-mediated dilation , carotid intima-media thickness , and high-sensitivity C-reactive protein , were measured before GBS and 6 , 12 , and 24 months after GBS . There were statistically significant improvements in all measured markers of coronary atherosclerosis after GBS . The mean body mass index decreased from 47 to 29.5 kg/m(2 ) at 24 months ( p < 0.001 ) , the mean carotid intima-media thickness regressed from 0.84 to 0.50 mm at 24 months ( p < 0.001 ) , mean flow-mediated dilation improved from 6.0 % to 14.9 % at 24 months ( p < 0.05 ) , and mean high-sensitivity C-reactive protein decreased from 1.23 to 0.65 mg/dl at 6 months ( p < 0.001 ) and to 0.35 mg/dl at 24 months ( p < 0.001 ) . In conclusion , GBS results in significant improvements in inflammatory , structural , and functional markers of coronary atherosclerosis Background : The objective of this study was to determine the weight loss , changes in co-morbidities , medication usage and general health status at 1 year after laparoscopic adjustable gastric b and ing ( LAGB ) .  Methods : Prospect i ve data were obtained from all subjects undergoing LAGB .  These measurements included a medical history and review of systems , medications , height and weight and the SF-36 general health survey . Patients were seen for b and adjustments as needed throughout the year . At the 1-year follow-up visit , patients were weighed and interviewed about the status of their health conditions and their current medications , and the SF-36 was repeated . Results : Between November 2002 and November 2003 , 195 patients had LAGB . The majority of subjects were female ( 82.8 % ) , married ( 65.1 % ) , and white ( 94.9 % ) .  Complications occurred in 18 subjects ( 9.2 % ) . These included 3 slipped b and s ( 1.5 % ) , 4 port problems ( 2.1 % ) , 8 patients with temporary stoma occlusion ( 4.1 % ) , 1 explantation ( 0.5 % ) , and 1 mortality ( 0.5 % ) . Mean BMI decreased from 45.8 kg/m2 ( ± 7.7 ) to 32.3 kg/m2 ( ± 7.0 ) . Mean percent excess body weight lost was 45.7 % ( ± 17.1 ) during the first year . Major improvements occurred in arthritis , asthma , depression , diabetes , gastro-esophageal reflux disease , hyperlipidemia , hypertension , joint and back pain , sleep apnea and stress incontinence . Medication usage declined remarkably . Quality of life ( QoL ) by the SF-36 showed highly significant improvements . Conclusions : At 1 year after LAGB , patients had experienced significant weight loss , resolution of comorbidities , decreases in medication usage , and improvements in BACKGROUND Roux-en-Y gastric bypass is currently considered the gold st and ard surgical option for the treatment of morbid obesity .  Open RYGB is associated with a high risk of complications . Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery . OBJECTIVES To review our experience with laparoscopic RYGB during a 19 month period . METHODS The data were collected prospect ively . The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007 . The reported outcome included surgical results , weight loss , and improved status of co-morbidities , with follow-up of up to 19 months . RESULTS The mean age of the 50 patients was 36.7 years . Mean body mass index was 44.7 kg/m2 ( range 35 - 76 kg/m2 ) ; mean duration of surgery was 171 minutes . There was no conversion to open surgery . The mean length of stay was 4 days ( range 2 - 7 days ) . Five patients ( 10 % ) developed a complication , but none of them required early reoperation and there were no deaths . Mean follow-up was 7 months ( range 40 days-19 months ) . The excess body weight loss was 55 % and 61 % at 6 and 12 months respectively . Diabetes resolved completely or significantly improved in all five patients with this condition , as did hypertension in eight patients out of nine . CONCLUSIONS Laparoscopic RYGB is feasible and safe . The results in terms of weight loss and correction of co-morbidities are comparable to other previously published studies . However , only surgeons with experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure HYPOTHESIS Outcome following laparoscopic adjustable gastric b and ing ( LAGB )  in super morbidly obese patients is significantly worse compared with the st and ard laparoscopic Roux-en-Y gastric bypass ( LRYGB ) . DESIGN Prospect i ve case series . SETTING Community teaching hospital ( 490 beds ) . PATIENTS A prospect ively maintained data base identified patients who underwent operative treatment for morbid obesity between February 2001 and June 2004 . The study group included super morbidly obese patients ( body mass index > 50 [ calculated as weight in kilograms divided by the square of height in meters ] ) following LAGB and LRYGB .  INTERVENTIONS Among 106 patients with super morbid obesity , 60 ( 57 % ) and 46 ( 43 % ) underwent LAGB and LRYGB  , respectively . MAIN OUTCOME MEASURES Patient demographics , weight loss , percentage of excess weight loss , change in body mass index , early ( < 30 days ) and late ( > or = 30 days ) complications , reoperations , medical comorbidity , and patient satisfaction were studied . Analysis was performed using the t test and Pearson chi 2 analysis . RESULTS Overall median follow-up was 16.2 months ( range , 1 - 40 months ) . Preoperative factors of patient age , sex , weight , body mass index , and medical comorbidity were similar between the 2 groups . Compared with LRYGB , patients who underwent LAGB experienced a greater incidence of late complications ( P < .05 ) , reoperations ( P < .04 ) , less weight loss ( P<.001 ) , and decreased overall satisfaction ( P < .006 ) . Likewise , patients who underwent LRYGB had a greater resolution of concomitant diabetes mellitus ( P < .05 ) and sleep apnea ( P<.01 ) compared with the LAGB group . Furthermore , postoperative adjustments to achieve consistent weight loss for LAGB recipients ranged from 1 to 15 manipulations . Our single mortality was in the LAGB group . CONCLUSIONS In super morbidly obese patients , LAGB is significantly associated with more late complications , reoperations , less weight loss , less reduction of medical comorbidity , and patient dissatisfaction compared with LRYGB . Further evaluation of LAGB in this patient population appears warranted Background Obesity has recently been cited as the number one killer in the USA . This problem is both a national and regional epidemic . The health care costs of obesity and obesity-related illnesses are ever increasing , and gastric bypass surgery is becoming a popular treatment strategy . Recently , reports describe not only surgical outcomes , but also quality of life outcomes . The bigger issue of obesity-related illness resolution is still evolving . Our institution has performed well over 500 gastric bypasses since 2002 . We evaluated over 100 patients prior to and 1 year after gastric bypass surgery .  Methods A prospect i ve study was design ed in order to systematic ally examine quality of life in  gastric bypass patients and couple the results with both objective and subjective assessment of bariatric surgery outcomes . One hundred nineteen patients undergoing gastric bypass at our institution from January 2005 to December of 2005 were enrolled in the study . In addition to routine preprocedural and postprocedural follow-up , completion of  quality of life  forms and anthropometric measurements were performed . Using these data , we then correlated the change in quality of life scores with social factors , weight loss success , and status of obesity-related conditions . We also examined the impact of alcohol intake and other demographic factors on both quality of life and obesity related conditions . Results A total of 119 patients were enrolled in the study during the calendar year 2005 . Follow-up at approximately 1 year ( average 12.86 months ) postsurgery was obtained in 75 patients . A significant reduction in weight ( 144.4 ± 34.4 vs. 91.5 ± 28.8 ; p < 0.0001 ) , body mass index ( 52.4 ± 12.2 vs. 32.3 ± 8.6 ; p < 0.0001 ) , mean systolic blood pressure ( 140.4 ± 14.7 vs. 130.0 ± 21.7 ; p < 0.001 ) , and lipids ( 194.3 ± 33.8 vs. 165.7 ± 32.1 ; p < 0.0001 ) was noted . Quality of life scores 1 year after gastric bypass surgery were also significantly improved ( 35.9 ± 19.5 vs. 82.2 ± 23.5 ; p < 0.0001 ) . There was also a significant reduction in the reported usage of medications for obesity related conditions . Various measures of success ( change in BMI , change in quality of life scores , and follow up health ranking ) were compared across demographic and social factors and no significant associations were identified . Conclusions Gastric bypass is associated with a reduction in weight , BMI , mean systolic blood pressure , cholesterol , and the usage of medications for obesity-related conditions . A significant improvement in quality of life was also noted 1 year after surgery 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 The Program on the Surgical Control of the Hyperlipidemias ( POSCH ) was a secondary atherosclerosis intervention trial employing partial ileal bypass surgery as the intervention modality . For this report , we analyzed 105 subgroups in 35 variables in POSCH , chosen predominantly for their potential relationship to the risk of atherosclerotic coronary heart disease ( ACHD ) . We defined potential differential effects as those with : ( 1 ) an absolute z-value > or = 2.0 for the subgroup , if the absolute z-value for the overall effect was < 2.0 ; and ( 2 ) an absolute z-value > or = 3.0 for the subgroup and a relative risk < or = 0.5 , if the absolute z-value for the overall effect was > or = 2.0 . For each of three major POSCH endpoints of overall mortality , ACHD mortality and ACHD mortality or confirmed nonfatal myocardial infa rct ion , we found seven subgroups with a differential risk reduction in the surgery group as compared to the control group . Allowing for identical subgroups for more than one endpoint , there were 13 individual subgroups with differential effects . Of these , seven demonstrated internal consistency across endpoints , and five of these seven displaced external consistency with known ACHD risk factors and for biological plausibility : triglyceride concentration > or = 200 mg/dl ; cigarette smoking ; overt or borderline diabetes mellitus ; a Minnesota ECG Q-QS code of 1 - 1 ; and obesity . A greater risk reduction , in comparison to the overall treatment effect , by the reduction of a single risk factor , hypercholesterolemia , in patients with at least two major ACHD risk factors was a provocative and an hypothesis-generating outcome of this analysis . The clinical implication s of this finding may lead to more aggressive cholesterol intervention in patients with multiple ACHD risk factors Background : Obesity is now one of our major public health problems . Effective and acceptable treatment options are needed . The Lap-B and ® system is placed laparoscopically and allows adjustment of the level of gastric restriction . Methods : A prospect i ve study of 709 severely obese patients was conducted over a 6-year period at a university-based multidisciplinary referral center . After extensive preoperative evaluation , patients with a body mass index > 35 were treated by  LapB and ® placement . Close follow-up with progressive adjustment of gastric restriction continued permanently . Medical co-morbidities were monitored as part of comprehensive prospect i ve data collection . Results : There have been no deaths perioperatively or during follow-up . Significant perioperative adverse events occurred in 1.2 % only . Reoperation has been needed for prolapse ( slippage ) in 12.5 % , erosion of the b and into the stomach in 2.8 % and for tubing breaks in 3.6 % . A steady progression of weight loss has occurred through the duration of the study with 52 ± 19 % EWL at 24 months ( n=333 ) , 53±22 % EWL at 36 months ( n=264 ) , 52 ± 24 % EWL at 48 months ( n=108 ) , 54 ± 24 % EWL at 60 months ( n=30 ) , and 57 ± 15 % EWL at 72 months ( n=10 ) . Major improvements have occurred in diabetes , asthma , gastroesophageal reflux , dyslipidemia , sleep apnea and depression . Quality of life as measured by R and SF-36 shows highly significant improvement . Conclusions : Placement of the Lap-B and ® system provides safe and effective control of severe obesity . The effect on weight loss is durable and is associated with major improvement in health and quality of life . It has the potential to provide a broadly acceptable option for this common and serious disease AIMS To evaluate the effect of weight loss after bariatric surgery ( BS )  on peripheral adipocytokines , renal parameters and other cardiovascular risk factors ( CVRFs ) . METHODS A total of 70 ( 41 women ) extremely obese adults were prospect ively studied before and 12 months after surgery . CONTROLS 24 ( 15 women ) normal-weight adults .  Anthropometric , biochemical and renal parameters were recorded . RESULTS Presurgery , adiponectin ( ADPN ) was lower , whereas leptin , insulin resistance , C-reactive protein , creatinine clearance and albuminuria were higher in patients than controls ( P<0.001 ) . All parameters improved postsurgery . Changes in ADPN correlated negatively with leptin , insulin resistance , albumin , C-reactive protein , and creatinine clearance . Multiple regression analysis : using changes in ADPN as the dependent variable , only changes in insulin resistance ( P=0.005 ) and albumin ( P=0.019 ) were significant independent determinants for changes in ADPN . No statistical differences were found in relation to the degree of obesity . CONCLUSION Patients changed to obesity type I after surgery . This implies a substantial improvement of CVRFs including ADPN , creatinine clearance and albuminuria . Changes in plasma ADPN correlated negatively with insulin resistance and with albuminemia but not with renal parameters . The lack of differences between different degrees of obesity suggests that the relationship between weight and CVRFs no longer exists when obesity becomes very extreme Background : Open or laparoscopic Roux-en-Y gastric bypass ( RYGBP ) is the most common operation for treatment of morbid obesity in USA . The laparoscopic adjustable gastric b and ( LAGB ) has been the most common bariatric operation performed worldwide . The LapB and ® was approved for use in USA in July 2001 . Since then , several US surgeons have adopted one procedure preferentially over the other , and several have reported patient outcomes . We added the option of the LAGB to the RYGBP in our practice in July 2001 . We hypothesized that both procedures will provide similar weight loss and co-morbidity reduction if followed for a sufficient length of time . To enhance weight loss , we adopted a patient behavioral program that is easy to remember , in an attempt to ensure a reduction in caloric intake and reduce hunger regardless of the operation performed . Methods : A case-controlled matched-pair cohort study was conducted . All patients who presented to the Surgical Weight Control Center of Las Vegas between Aug 2001 and Aug 2004 for LAGB were placed into one group , and a matched-pair RYGBP cohort group was created . Patients in the RYGBP cohort were matched for age , sex , date of surgery , and BMI . All patients were evaluated on an intention to treat basis . Data were collected prospect ively and analyzed retrospectively . All patients were subjected to the same preoperative education regarding calorie reduction behaviors and diet change , and received the same postoperative counseling regarding long-term eating behavior and food choices . Results : During this period , 208 patients underwent LAGB and 600 underwent RYGBP .  Of the 208 LAGB patients , 181 had suitable open or laparoscopic RYGBP matches . The two groups were similar in terms of age , sex , BMI , and co-morbidities . There were no deaths in either group . Resolution of co-morbidities statistically favored RYGBP as did the weight loss , over the study period . Conclusion : When patients are matched with 3-year follow-up according to time of surgery , age , sex and BMI , LRYGBP provides superior weight and co-morbidity reduction and can be done without severe complications . However , the LAGB is an effective weight loss tool and not every patient wishes to have the LRYGBP BACKGROUND Super-obese patients can achieve adequate weight loss with long limb Roux-en-Y gastric bypass ( RYGB ) . These patients , however , might need longer intestinal limbs to control co-morbidities such as type 2 diabetes , lipid disorders , hypertension , sleep apnea , and gastroesophageal reflux disorder . METHODS A total of 105 patients with a body mass index of > or = 50 kg/m(2 ) were r and omly divided into 2 similar groups regarding sex , age , and number of co-morbidities . All underwent laparoscopic Roux-en-Y gastric bypass .  In group 1 , the length of the biliary limb was 50 cm and the length of the Roux limb was 150 cm . In group 2 , the length of the biliary limb was 100 cm and the length of the Roux limb was 250 cm . RESULTS The follow-up for both group was 48 months . Diabetes was controlled in 58 % of group 1 and in 93 % of group 2 ( P < 0.05 ) . Lipid disorders improved in 57 % of group 1 and in 70 % of group 2 ( P < 0.05 ) . No statistical difference was found in the control or improvement of hypertension , sleep apnea , or gastroesophageal reflux disorder . The excess weight loss was faster in group 1 but was similar in both groups at 48 months ( 70 % in group 1 and 74 % in group 2 ) , with no statistical difference . CONCLUSION Patients with longer biliary and Roux limbs achieved greater type 2 diabetes control , greater lipid disorder improvement , and showed a trend toward faster excess weight loss Objective : To analyze long-term weight loss , changes in comorbidities and quality of life , and late complications after  laparoscopic and open gastric bypass .  Summary Background Data : Early results from our prospect i ve r and omized trial comparing the outcome of laparoscopic versus open gastric bypass demonstrated less postoperative pain , shorter length of hospital stay , fewer wound-related complications , and faster convalescence for patients who underwent laparoscopic gastric bypass .  Methods : Between May 1999 and March 2001 , 155 morbidly obese patients were enrolled in this prospect i ve trial , in which 79 patients were r and omized to laparoscopic gastric bypass and 76 to open gastric bypass .  Two patients in the laparoscopic group required conversion to open surgery ; their data were analyzed within the laparoscopic group on an intention-to-treat basis . The 2 groups were well matched for body mass index , age , and gender . Outcome evaluation included weight loss , changes in comorbidities and quality of life , and late complications . Results : The mean follow-up was 39 ± 8 months . There were no significant differences in the percent of excess body weight loss between the 2 groups at the 3-year follow-up ( 77 % for laparoscopic versus 67 % for open ) . The rate of improvement or resolution of comorbidities was similar between groups . Improvement in quality of life , measured by the Moorehead-Ardelt Quality of Life Question naire , was observed in both groups without significant differences between groups . Late complications were similar between groups except for the rate of incisional hernia , which was significantly greater after open gastric bypass ( 39 % versus 5 % , P < 0.01 ) , and the rate of cholecystectomy , which was greater after laparoscopic gastric bypass ( 28 % versus 5 % , P = 0.03 ) . Conclusions : In this r and omized trial with a 3-year follow-up , we found that laparoscopic gastric bypass was equally effective as open gastric bypass with respect to weight loss and improvement in comorbidities and quality of life . A major advantage at long-term follow-up for patients who underwent laparoscopic gastric bypass  was the reduction in the rate of incisional hernia Background : Severe obesity is associated with type 2 diabetes and hypertension . Improvement in these comorbidities after surgically-induced weight loss has been documented , and laparoscopic adjustable gastric b and ing ( LAGB ) is an effective weight loss operation . Methods : Of 840 patients who underwent Lap-B and ® , data are available in 402 out of 413 patients whose surgery took place at ≥ 1 year ago . Preoperative and follow-up data were studied retrospectively to examine the effect of Lap-B and ® -induced weight loss on diabetes and hypertension . Results : Of 413 patients with at least 1 year postoperative follow-up , 53 ( 12.8 % ) were taking medications for type 2 diabetes preoperatively and 189 ( 45.7 % ) were on antihypertensive medications . 66 % ( n=35 ) of diabetic patients were also hypertensive . Resolution of diabetes was observed in 66 % at 1-year and 80 % at 2-year follow-up . HbA1c dropped from 7.25 % ( 5.6 - 11.0 , n=53 ) preoperatively to 5.58 % ( 5.0 - 6.2 , n=15 ) at 2 years after surgery . Hypertension resolved in 59.8 % and 74 % at 1 and 2 years , respectively . Percent excess weight loss ( % EWL ) was lower for diabetic patients than for our cohort population ( 39.2 % vs 41.2 % at 1 year , 46.7 % vs 54.2 % at 18 months , and 52.6 % vs 63.3 % at 2 years , respectively ) . Patients in whom diabetes was improved but not resolved had lower % EWL than did those whose diabetes went into remission ( 27.0 % at 1 year and 26.5 % at 2 years ) . Patients with the shortest duration of diabetes ( < 5 years ) and better weight loss after surgery achieved higher resolution rates . Conclusions : Dramatic improvement in – and frequent resolution of – diabetes and hypertension have been observed as a result of weight loss after Lap-B and ® surgery BACKGROUND AND METHODS The Program on the Surgical Control of the Hyperlipidemias ( POSCH ) , a r and omized clinical trial , was design ed to test whether cholesterol lowering induced by the partial ileal bypass operation would favorably affect overall mortality or mortality due to coronary heart disease . The study population consisted of 838 patients ( 417 in the control group and 421 in the surgery group ) , both men ( 90.7 percent ) and women , with an average age of 51 years , who had survived a first myocardial infa rct ion . The mean follow-up period was 9.7 years . RESULTS When compared with the control group at five years , the surgery group had a total plasma cholesterol level 23.3 percent lower ( 4.71 + /- 0.91 vs. 6.14 + /- 0.89 mmol per liter [ mean + /- SD ] ; P less than 0.0001 ) , a low-density lipoprotein cholesterol level 37.7 percent lower ( 2.68 + /- 0.78 vs. 4.30 + /- 0.89 mmol per liter ; P less than 0.0001 ) , and a high-density lipoprotein cholesterol level 4.3 percent higher ( 1.08 + /- 0.26 vs. 1.04 + /- 0.25 mmol per liter ; P = 0.02 ) . Overall mortality and mortality due to coronary heart disease were reduced , but not significantly so ( deaths overall [ control vs. surgery ] , 62 vs. 49 , P = 0.164 ; deaths due to coronary disease , 44 vs. 32 , P = 0.113 ) . The overall mortality in the surgery subgroup with an ejection fraction greater than or equal to 50 percent was 36 percent lower ( control vs. surgery , 39 vs. 24 ; P = 0.021 ) . The value for two end points combined -- death due to coronary heart disease and confirmed nonfatal myocardial infa rct ion -- was 35 percent lower in the surgery group ( 125 vs. 82 events ; P less than 0.001 ) . During follow-up , 137 control-group and 52 surgery-group patients underwent coronary-artery bypass grafting ( P less than 0.0001 ) . A comparison of base-line coronary arteriograms with those obtained at 3 , 5 , 7 , and 10 years consistently showed less disease progression in the surgery group ( P less than 0.001 ) . The most common side effect of partial ileal bypass was diarrhea ; others included occasional kidney stones , gallstones , and intestinal obstruction . CONCLUSIONS Partial ileal bypass produces sustained improvement in the blood lipid patterns of patients who have had a myocardial infa rct ion and reduces their subsequent morbidity due to coronary heart disease . The role of this procedure in the management of hypercholesterolemia remains to be determined . These results provide strong evidence supporting the beneficial effects of lipid modification in the reduction of atherosclerosis progression Background Bariatric surgery is being conducted more often for morbid obesity , but little evidence exists about how it affects the risk of future cardiovascular events . The goal of this study was to quantify the change in predicted 10-year cardiovascular risk following  laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) .  Methods We conducted a prospect i ve clinical study of morbidly obese adults undergoing LRYGBP at a university hospital in the USA . Our primary outcome measure was mean change in 10-year cardiovascular risk at 12 months . We estimated cardiovascular risk by using the Framingham risk equation , which calculates the absolute risk of cardiovascular events for patients with no known history of heart disease , stroke , or peripheral vascular disease by using information on age , sex , blood pressure , total and high-density lipoprotein cholesterol levels , smoking status , and history of diabetes . Results Ninety-two participants underwent LRYGBP between December 2004 and October 2005 . Their predicted baseline 10-year cardiovascular risk was 6.7 % . At 6 and 12 months , their predicted risk had decreased to 5.2 % and 5.4 % , respectively . Assuming no change in risk among untreated patients , this represents an absolute risk reduction of 1.3 % ; which suggests that 77 morbidly obese patients would have to undergo LRYGBP  to avert one new case of cardiovascular disease over the ensuing 10 years ( number needed to treat = 77 ) . Conclusion Our findings indicate that LRYGBP is associated with improvements in cardiovascular risk factors and a corresponding decrease in predicted 10-year risk of cardiovascular disease The aim of this study was to examine the effect of surgical weight reduction on cardiac structure and function and to seek the determinants of these changes . Sixty-six severely obese adults ( BMI > or=35 kg/m(2 ) ) who received bariatric surgery  underwent  echocardiographic examination  before and 3 months after surgery . At 3 months after surgery , BMI and systolic blood pressure ( BP ) decreased ( 43.3 + /- 6.3 to 34.1 + /- 5.6 kg/m(2 ) , P < 0.001 , and 146 + /- 12 to 130 + /- 14 mm Hg , P < 0.001 , respectively ) . In left ventricular ( LV ) geometry , the relative wall thickness ( RWT ) and LV mass index decreased significantly ( 0.43 + /- 0.05 to 0.35 + /- 0.05 , P < 0.001 , and 50 + /- 11 to 39 + /- 11 g/m(2.7 ) , P < 0.001 , respectively ) without changes in chamber size . Multivariate analyses showed change in systolic BP to be an independent predictor for the changes in RWT and LV mass index . In myocardial performance , peak systolic mitral annular velocity and all diastolic indexes showed significant improvements . We concluded that LV hypertrophy and function improved rapidly after bariatric surgery  in severely obese adults .  BP reduction was the major determinant for the regression of LV hypertrophy in the early stage of surgical weight reduction BACKGROUND In 1990 , when the Program on the Surgical Control of the Hyperlipidemias ( POSCH ) reported its in-trial results strongly supporting the conclusion that effective lipid modification reduces progression of atherosclerosis , the differences for the end points of overall mortality and mortality from atherosclerotic coronary heart disease ( ACHD ) did not reach statistical significance . METHODS The Program on the Surgical Control of the  Hyperlipidemias recruited men and women with a single documented myocardial infa rct ion between the ages of 30 and 64 years who had a plasma cholesterol level higher than 5.69 mmol/L ( 220 mg/dL ) or higher than 5.17 mmol/L ( 200 mg/dL ) if the low-density lipoprotein cholesterol level was in excess of 3.62 mmol/L ( 140 mg/dL ) . Between 1975 and 1983 , 838 patients were r and omized : 417 to the diet control group and 421 to the diet plus partial ileal bypass intervention group .  Mean patient follow-up for this 5-year posttrial report was 14.7 years ( range , 12.2 - 20 years ) . RESULTS At 5 years after the trial , statistical significance was obtained for differences in overall mortality ( P = .049 ) and mortality from ACHD ( P = .03 ) . Other POSCH end points included overall mortality ( left ventricular ejection fraction > or = 50 % ) ( P = .01 ) , mortality from ACHD ( left ventricular ejection fraction > or = 50 % ) ( P = .05 ) , mortality from ACHD and confirmed nonfatal myocardial infa rct ion ( P<.001 ) , confirmed nonfatal myocardial infa rct ion ( P<.001 ) , mortality from ACHD , confirmed and suspected myocardial infa rct ion and unstable angina ( P<.001 ) , incidence of coronary artery bypass grafting or percutaneous transluminal coronary angioplasty ( P<.001 ) , and onset of clinical peripheral vascular disease ( P = .02 ) . There were no statistically significant differences between groups for cerebrovascular events , mortality from non-ACHD , and cancer .  All POSCH patients have been available for follow-up . CONCLUSION At 5 years after the trial , all POSCH mortality and atherosclerosis end points , including overall mortality and mortality from ACHD , demonstrated statistically significant differences between the study groups BACKGROUND Obesity and its related comorbid illnesses have become a national health priority . We report comorbidity and quality of life ( QoL ) data after  weight loss with gastric b and ing  using the Swedish Adjustable Gastric B and ( SAGB ) . METHODS Data were collected prospect ively for 838 consecutive morbidly obese patients who underwent laparoscopic adjustable gastric b and ing ( LAGB ) between January 2001 and July 2007 . Patients were followed-up by a multidisciplinary team consisting of a surgeon , physician , dietician , and exercise consultant , all of whom were involved in the evaluation of clinical outcomes . Continuous data were reported as mean + /- SD ; categorical data were reported as number and percentage . Patients served as their own controls . RESULTS Respective preoperative mean age , weight , and body mass index ( BMI ) were 44 years ( range 16 - 76 ) , 122 kg ( range 86 - 240 ) , and 44 kg/m2 ( range 35 - 86 ) , respectively . SAGB implantation was accomplished by the pars flaccida technique with no conversion to an open procedure . Mature follow-up data were available for 35 % of patients at 24 months and 21 % at 36 months . In the total cohort of 838 patients , BMI ( mean + /- SD ) decreased to 32 + /- 5 kg/m2 and 32 + /- 7 kg/m2 at 24 months and 36 months , respectively . Percentage excess weight loss ( % EWL ) ( mean + /- SD ) was 32 % + /- 14 % ( n = 506 ) , 47 % + /- 15 % ( n = 461 ) , 52 % + /- 16 % ( n = 291 ) , and 54 % + /- 23 % ( n = 175 ) at 6 , 12 , 24 , and 36 months , respectively ( P < .001 ) . There were 545 patients identified with comorbid illness at > 6-month follow-up . After a median follow-up of 13 months ( range 6 - 36 months ) , resolution and /or improvement of comorbidities was as follows : type 2 diabetes mellitus , 79 % ; metabolic syndrome , 78 % ; hypertension , 67 % ; dyslipidemia , 66 % ; gastroesophageal reflux , 66 % ; asthma , 57 % ; arthritis/joint pain , 70 % ; polycystic ovarian syndrome , 48 % ; and depression , 57 % . There was a significant improvement in QoL ( as measured by the Short Form-36 Health Survey [ SF-36 ] ) , bringing patients ' QoL to a level consistent with that of community norms in all 8 domain scores . Of 342 patients surveyed with the Beck Depression Inventory ( BDI-II ) , a statistically significant improvement in depressive mood was also observed ( P < .001 ) . CONCLUSION Weight loss achieved by use of the SAGB provides a dramatic reduction in many serious comorbid illnesses as well as improvement in the psychosocial wellbeing of morbidly obese patients 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 : Morbid obesity has been described as a continuing epidemic affecting a growing portion of our population . We report an outcome analysis of our early experience with laparoscopic Roux-en-Y gastric bypass ( LRYGB )  in the treatment of morbid obesity . Methods : Two surgeons performed 116 consecutive LRYGBs at a single institution , creating a 25-ml pouch and a 90- to 150-cm Roux limb . The prospect ively collected data included patient demographics , comorbidities , postoperative weight loss , and complications . Results : All eight conversions to an open procedure occurred early during the experience of the surgeons . The mean operating room time for the first 50 cases was 272 min , which decreased to 198 min with experience . The mean length of hospital stay was 3 days . There were 34 complications in 27 patients ( 23.3 % ) , 14 of which ( 12 % ) required reoperation . At 18 months postoperatively , the patients had lost 77 % of their excess weight , and their body mass index had decreased from a mean of 49.3 to 32.6 kg/m2 . As a result of LRYGB , 25 % of the patients were rendered completely free of any pharmacologic treatment for their preexisting comorbidities . Conclusions : Although technically challenging , LRYGB can be performed safely with excellent long-term results . The mean operating room time and conversion rate improved with experience . As this study showed , LRYGB achieves an excellent rate of weight loss and improvement in preoperative comorbidities with a minimal length of hospital stay and an acceptable complication rate
target: In conclusion , this review highlights the benefits of bariatric surgery in reducing or eliminating risk factors for CVD .
  It provides further evidence to support surgical treatment of obesity to achieve CVD risk reduction
background: Obesity is associated with increased risk for cardiovascular ( CV ) disease ( CVD ) and CV mortality .
  Bariatric surgery has been shown to resolve or improve CVD risk factors , to varying degrees .
  The objective of this systematic review was to determine the impact of bariatric surgery on CV risk factors and mortality .
  A systematic review of the published research was performed to evaluate evidence regarding CV outcomes in morbidly obese bariatric patients .