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The Impact of Roux-en-Y gastric Bypass on Inflammation and Cardiovascular Disease

Hinerman, Amanda (2021) The Impact of Roux-en-Y gastric Bypass on Inflammation and Cardiovascular Disease. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

In the United States (US), cardiovascular disease (CVD), which includes several conditions where the heart or blood vessels have decreased functionality, is the cause of 1 in 3 deaths. CVD risk increases with higher degrees of excess adiposity. Bariatric surgery, the most effective treatment for severe obesity, has been associated with a decrease in CVD-related risk factors, but there is a dearth of research evaluating the heterogeneity and sustainability of the effect of bariatric surgery on CVD risk.
This study evaluated a cohort of 1770 US adults who underwent Roux-en-Y gastric bypass (RYGB) surgery (one of two common bariatric surgical procedures) and were followed annually for up to 7 years. Sex-specific 10-year and lifetime predicted CVD risks were calculated among participants with no CVD history (N=1234) using validated scoring algorithms (Framingham-lipid, Framingham-body mass index [BMI], Atherosclerotic [ASCVD]). Mean 10-year and lifetime CVD risks were substantially lower and fewer participants were categorized as having high risk throughout 7 years post-surgery versus pre-surgery, with all scores. However, magnitude of change differed by risk score. Several individual-level factors (male versus female sex, lower versus higher household income, and abnormal versus normal kidney function) were associated with smaller reductions in 10-year/lifetime CVD risks. Participants (N=1180) also experienced substantial mean improvement in C-reactive protein (CRP), a biomarker of CVD risk and non-specific low-grade systemic inflammation, and a reduction from 33% to 3% in elevated CRP (≥1 mg/L) at 7 years versus pre-surgery. Across 7 years of follow-up, the non-fatal CVD event rate per 1000 person-years was 50.4 (95% CI:41.6,61.2) for females and 71.6 (95% CI:53.7,95.5) for males. Standardized mortality ratios (SMRs) for CVD-related mortality indicated a higher mortality rate in the post-RYGB sample compared to the general population.
These findings have direct public health significance by informing the variability and sustainability of CVD risk reductions, including inflammation, associated with RYGB, and determining the post-RYGB CVD event rate. Although RYGB results in substantial CVD risk reduction, CVD-related mortality indicates post-surgical patients are still a high-risk group. This research offers insights into which patients might require additional support beyond RYGB surgery to improve their cardiovascular health.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Hinerman, Amandaash15@pitt.eduash150000-0001-8167-2463
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairKing, Wendykingw@edc.pitt.edu
Committee MemberBarinas-Mitchell, Emmabarinas@edc.pitt.edu
Committee MemberCourcoulas, Anitacourcoulasap@msx.upmc.edu
Committee MemberEl Khoudary, Samarsae25@pitt.edu
Committee MemberWahed, Abduswaheda@edc.pitt.edu
Date: 19 January 2021
Date Type: Publication
Defense Date: 20 November 2020
Approval Date: 19 January 2021
Submission Date: 1 December 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 185
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: cardiovascular disease, bariatric surgery, inflammation, weight loss, weight regain
Date Deposited: 19 Jan 2021 21:09
Last Modified: 19 Jan 2021 21:09
URI: http://d-scholarship.pitt.edu/id/eprint/39951

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