Hinerman, Amanda
(2021)
The Impact of Roux-en-Y gastric Bypass on Inflammation and Cardiovascular Disease.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
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: |
|
| ETD Committee: |
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| 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: |
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 2023 06:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/39951 |
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