Weight Loss Surgery and Major Cardiovascular Risk Factors
Weight-loss surgery is an effective treatment for severe, medically complicated and refractory obesity. It reverses, eliminates or significantly ameliorates major cardiovascular risk factors related to obesity. In a large proportion of patients, the therapy produces significant weight loss, reduces the risk of disability and premature death, and improves quality of life. Surgical treatment by gastric-restrictive and malabsorptive procedures started several decades ago in the US. Since the 1970s, accrued clinical experience and advances in technology, particularly in minimally invasive surgical approaches, have changed this therapy. Some procedures have evolved, whereas others have become obsolete. Today's weight-loss operations are safe, effective and potentially life-saving options for severely obese cardiology patients. This review describes weight-loss surgery procedures and their effects on cardiovascular risk factors.

Obesity is associated with increased morbidity and mortality. Cardiovascular comorbidities of obesity include coronary artery disease, hypertension, congestive heart failure, pulmonary hypertension, deep-vein thrombosis and pulmonary embolism. The effects of morbid obesity on the risks of hypertension, coronary artery disease and vascular disorders have been well documented.

The WHO has recognized an epidemic of obesity throughout most of the developed and developing world. The prevalence of this condition (defined as BMI >30 kg/m), which affects approximately 300 million people worldwide, is increasing in most populations and age-groups. Bariatric surgery is an appropriate treatment for patients with class II obesity (defined as BMI 35-40 kg/m) and major comorbidities, or class III obesity (defined as BMI >40 kg/m, Table 1 ). In a hospital-based observational cohort study, Christou et al. reported reductions in the relative risk of death of up to 89% in patients who had weight-loss surgery compared with those who did not. In this review, we describe weight-loss surgery procedures and their effects on cardiovascular risk factors. We followed the US Preventive Health Service guidelines, the American Dietetic Association, and other criteria of evidence-based medicine.