An Assessment of the Effect of Bariatric Surgery on Cardiovascular Disease Risk in the Chinese Population Using Multiple Cardiovascular Risk Models

Figures & data

Table 1 Patient Demographics According to BMI

Characteristic	All (n = 61)	BMI ≥ 35 kg/m^2 (n = 24)	BMI < 35 kg/m^2 (n = 37)	P value
Age, yr	45 (37.5, 52)	44 (37, 52.5)	45.89 ± 7.7	0.615
Male (Female)	30 (31)	15 (9)	15 (22)	0.094
SG/RYGB	26/35	16 (8)	10 (27)	<0.01
Smoking (%)	8 (13.11%)	6 (25%)	2 (5.41%)	0.068
Duration of diabetes, yr	2.00 (1.00, 7.5)	1.00 (1, 5.25)	5 (0.5, 8)	0.143
Weight, kg	90.1 (84, 110)	113.05 ± 14.1	85.53 ± 8.46	<0.01
BMI, kg/m^2	33.06 (30.44, 39.33)	39.24 ± 1.81	30.94 ± 1.99	<0.01
WC, cm	109.07 ± 12.98	119.33 ± 10.67	102.42 ± 9.61	<0.01
SBP, mmHg	130 (120, 150)	142.42 ± 19.72	129 (119.5, 142)	<0.05
DBP, mmHg	80 (78, 91)	84 (80, 98.75)	80 (76.5, 90)	0.082
FPG, mmol/L	7.57 (6.35, 10.95)	7.35 (6.2, 10.98)	7.92 (6.38, 10.96)	0.883
HbA1c,%	6.8 (5.95, 8.95)	6.85 (6, 7.8)	6.8 (5.8, 9)	0.749
TC, mmol/L	5.10 ± 1.02	5.05 ± 0.9	5.14 ± 1.1	0.756
TG, mmol/L	1.78 (1.32, 3.08)	1.89 (1.34, 3.71)	1.77 (1.31, 2.88)	0.488
HDL, mmol/L	1.04 ± 0.23	1.01 ± 0.18	1.06 ± 0.25	0.394
LDL, mmol/L	2.90 ± 0.87	2.91 ± 0.92	2.88 ± 0.84	0.912

Abbreviations: BMI, body mass index; yr, year; SG, sleeve gastrectomy; RYGB, Roux-en-Y gastric bypass; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; TC, serum total cholesterol; TG, serum triglycerides; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Table 2 Patient Demographics According to Gender

Characteristic	All (n=61)	Male (n=30)	Female (n=31)	P value
Age, yr	45 (37.5, 52)	45 (37, 52.5)	45 (39, 52)	0.994
SG/RYGB	26/35	12 (18)	14 (17)	0.684
Smoking (%)	8 (13.11%)	6 (20%)	2 (6.45%)	0.235
Duration of diabetes	2 (1, 7.5)	2 (1, 7)	3 (0, 8)	0.844
Weight, kg	90.1 (84, 110)	105.42 ± 19.05	87.59 ± 9.66	<0.01
BMI, kg/m^2	33.06 (30.44, 39.33)	35.45 (31.04, 39.45)	32.97 (29.74, 36.72)	0.379
WC, cm	109.07 ± 12.98	110.7 ± 15.75	107.5 ± 9.59	0.345
SBP, mmHg	130 (120, 150)	130 (120, 155.25)	135.48 ± 19.67	0.783
DBP, mmHg	80 (78, 91)	82.5 (80, 94)	80 (75, 90)	0.077
FPG, mmol/L	7.57 (6.35, 10.95)	8.95 (6.29, 11.62)	7.34 (6.41, 9.58)	0.184
HbA1C,%	6.8 (5.95, 8.95)	7.55 (6.03, 9.4)	6.7 (5.85, 7)	<0.05
TC, mmol/L	5.1 ± 1.02	5.02 ± 1.07	5.18 ± 0.98	0.550
TG, mmol/L	1.78 (1.32, 3.08)	2.3 (1.38, 4.14)	1.67 (1.31, 2.29)	<0.05
HDL, mmol/L	1.04 ± 0.23	0.92 (0.83, 1.08)	1.13 ± 0.19	<0.05
LDL, mmol/L	2.9 ± 0.87	2.62 ± 0.86	3.17 ± 0.79	<0.05

Abbreviations: BMI, body mass index; yr, year; SG, sleeve gastrectomy; RYGB, Roux-en-Y gastric bypass; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; TC, serum total cholesterol; TG, serum triglycerides; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Figure 1 Mean changes in measures of weight loss and glycemic control from baseline to 1 years.

Notes: (A–H) Represents the change curves of BMI, Waist, FPG, HbA1c, SBP, DBP, TC, and HDL before surgery, 3 months and 12 months after surgery, respectively.

Figure 2 Mean changes in measures of weight loss and glycemic control from baseline to 1 years between the 2 groups. (BMI ≥ 35kg/m² versus BMI < 35kg/m²).

Notes: (A–H) Represents the change curves of BMI, Waist, FPG, HbA1c, SBP, DBP, TC, and HDL before surgery, 3 months and 12 months after surgery in BMI≥35 kg/m² and BMI<35 kg/m² groups, respectively.

Figure 3 Mean changes in measures of weight loss and glycemic control from baseline to 1 years between the 2 groups. (Male versus Female).

Notes: (A–H) Represents the change curves of BMI, Waist, FPG, HbA1c, SBP, DBP, TC, and HDL before surgery, 3 months and 12 months after surgery in Male and Female groups, respectively.

Table 3 10-Yr Cardiovascular Risk Between BMI ≥ 35 kg/m² and BMI < 35 kg/m²

	Baseline	3 Mo	12 Mo
WHO risk model (TC)
Overall	8.00 (5.00, 13.50)	5.00 (3.00, 7.00)*	4.00 (2.00, 6.00)*
BMI ≥ 35 kg/m^2	9.00 (7.25, 14.00)	5.00 (3.00, 7.00)*	4.00 (2.50, 5.00)*
BMI < 35 kg/m^2	8.00 (5.00, 12.50)	5.00 (3.00, 9.00)*	4.00 (2.00, 6.75)*
p value	> 0.05	> 0.05	> 0.05
WHO risk model (BMI)
Overall	5.00 (3.00, 9.50)	4.00 (3.00, 7.00)	4.00 (3.00, 6.00)
BMI ≥ 35 kg/m^2	8.00 (4.00, 10.75)	5.00 (4.00, 8.50)	5.00 (3.00, 6.00)
BMI < 35 kg/m^2	4.00 (3.00, 8.00)	4.00 (3.00, 6.00)	4.75 ± 2.65
p value	< 0.01	< 0.05	> 0.05
Global risk model (TC)
Overall	12.00 (6.50, 18.00)	5.00 (3.00, 10.00)*	3.00 (2.00, 7.50)*
BMI ≥ 35 kg/m^2	14.00 (7.25, 18.00)	4.50 (3.00, 8.00)*	3.00 (2.00, 5.00)*
BMI < 35 kg/m^2	11.00 (5.50, 17.50)	6.20 (3.70, 10.50)*	4.00 (3.00, 8.00)*
p value	> 0.05	>0.05	> 0.05
Global risk model (BMI)
Overall	7.00 (4.00, 11.00)	4.00 (3.00, 8.00)*	4.00 (2.00, 7.00)*
BMI ≥ 35 kg/m^2	9.00 (6.00, 13.00)	6.00 (4.00, 10.50)*	4.00 (2.50, 7.50)*
BMI < 35 kg/m^2	5.00 (3.00, 9.50)	3.00 (2.00, 6.25)*	4.00 (2.00, 7.00)
p value	< 0.01	< 0.05	> 0.05
Framingham Risk score (lipid)
Overall	11.80 (6.75, 19.35)	6.85 (4.05, 11.03)*	4.20 (1.35, 6.73)*
BMI ≥ 35 kg/m^2	14.75 (9.53, 20.75)	8.25 ± 4.15*	4.35 (1.20, 6.15)*
BMI < 35 kg/m^2	10.70 (5.10, 17.00)	6.20 (3.70, 10.50)*	3.85 (1.35, 7.58)*
p value	< 0.05	> 0.05	> 0.05
Framingham Risk score (BMI)
Overall	14.50 (8.05, 24.00)	8.20 (4.00, 12.00)*	6.50 (3.20, 9.90)*
BMI ≥ 35 kg/m^2	16.90 (12.43, 27.80)	9.05 ± 4.04*	6.88 ± 3.05*
BMI < 35 kg/m^2	11.30 (5.95, 19.15)	7.25 (3.48, 13.38)*	5.55 (1.98, 13.50)*
p value	< 0.01	> 0.05	> 0.05

Note: *P< 0.05 compared with baseline in patients.

Abbreviations: BMI, body mass index; yr, year; TC, serum total cholesterol; mo, month.

Table 4 10-Yr Cardiovascular Risk Between Male and Female

	Baseline	3 Mo	12 Mo
WHO risk model (TC)
Overall	8.00 (5.00, 13.50)	5.00 (3.00, 7.00)*	4.00 (2.00, 6.00)*
Male	10.00 (6.00, 13.25)	5.00 (4.00, 8.50)*	4.00 (3.00, 7.00)*
Female	8.00 (5.00, 14.00)	5.00 (2.00, 7.00)*	4.00 (2.00, 6.00)*
p value	> 0.05	> 0.05	> 0.05
WHO risk model (BMI)
Overall	5.00 (3.00, 9.50)	4.00 (3.00, 7.00)	4.00 (3.00, 6.00)
Male	7.63 ± 4.06	5.00 (4.00, 8.00)	5.27 ± 2.34*
Female	4.00 (3.00, 8.00)	3.50 (3.00, 6.50)	3.50 (2.75, 6.25)
p value	> 0.05	> 0.05	> 0.05
Global risk model (TC)
Overall	12.00 (6.50, 18.00)	5.00 (3.00, 10.00)*	3.00 (2.00, 7.50)*
Male	10.50 (5.75, 16.00)	4.00 (3.00, 8.50)*	3.00 (2.00, 6.00)*
Female	16.00 (8.00, 21.00)	6.00 (3.00, 13.25)*	3.50 (2.00, 8.00)*
p value	> 0.05	> 0.05	> 0.05
Global risk model (BMI)
Overall	7.00 (4.00, 11.00)	4.00 (3.00, 8.00)*	4.00 (2.00, 7.00)*
Male	8.23 ± 4.58	5.00 (3.00, 8.00)*	4.00 (2.00, 6.00)*
Female	6.00 (3.00, 10.00)	3.00 (3.00, 6.75)*	3.50 (2.00, 8.00)
p value	> 0.05	> 0.05	> 0.05
Framingham risk score (lipid)
Overall	11.80 (6.75, 19.35)	6.85 (4.05, 11.03)*	4.20 (1.35, 6.73)*
Male	16.40 (9.45, 22.23)	7.50 (5.90, 13.15)*	4.80 (3.28, 8.45)*
Female	10.10 (4.90, 15.70)	4.40 (3.00, 10.00)*	2.40 (0.95, 5.78)*
p value	< 0.01	< 0.01	> 0.05
Framingham risk score (BMI)
Overall	14.50 (8.05, 24.00)	8.20 (4.00, 12.00)*	6.50 (3.20, 9.90)*
Male	16.90 (11.80, 26.18)	10.00 (6.70, 16.20)*	9.16 ± 4.90*
Female	10.70 (4.80, 15.80)	4.60 (3.00, 9.35)*	3.65 (1.80, 6.83)*
p value	< 0.01	< 0.01	< 0.01

Note: *P< 0.05 compared with baseline in patients.

Abbreviations: BMI, body mass index; yr, year; TC, serum total cholesterol; mo, month.

Table 5 30-Yr Cardiovascular Risk Between BMI ≥ 35 kg/m² and BMI < 35 kg/m²

	Baseline	3 Mo	12 Mo
30-year Full CVD (Lipid)
Overall	51.41 ± 20.81	35.04 ± 16.36*	20.00 (10.00, 39.00)*
BMI ≥ 35 kg/m^2	57.25 ± 18.22	35.89 ± 15.76*	22.00 (9.00, 51.50)*
BMI < 35 kg/m^2	47.62 ± 21.73	34.47 ± 16.99*	25.31 ± 20.43*
P value	> 0.05	> 0.05	> 0.05
30-year Hard CVD (Lipid)
Overall	37.41 ± 19.86	19.00 (11.25, 29.50)*	12.00 (4.00, 19.50)*
BMI ≥ 35 kg/m^2	42.79 ± 17.78	21.48 ± 11.77*	12.00 (4.50, 31.50)*
BMI < 35 kg/m^2	33.92 ± 20.58	19.00 (11.00, 30.00)*	10.50 (3.50, 19.75)*
P value	> 0.05	> 0.05	> 0.05
30-year Full CVD (BMI)
Overall	60.00 (40.50, 78.00)	37.40 ± 17.10*	29.00 ± 15.24*
BMI ≥ 35 kg/m^2	69.29 ± 16.84	38.52 ± 14.84*	29.38 ± 9.63*
BMI < 35 kg/m^2	51.19 ± 21.62	36.71 ± 18.53*	28.69 ± 18.95*
P value	< 0.01	> 0.05	> 0.05
30-year Hard CVD (BMI)
Overall	46.05 ± 22.09	24.00 (14.00, 33.00)*	17.00 (8.50, 24.50)*
BMI ≥ 35 kg/m^2	57.25 ± 18.83	25.33 ± 12.66*	18.23 ± 6.98*
BMI < 35 kg/m^2	38.78 ± 21.19	24.50 (9.75, 33.25)*	13.50 (6.00, 28.00)*
P value	< 0.01	> 0.05	> 0.05

Note: *P< 0.05 compared with baseline in patients.

Abbreviations: BMI, body mass index; yr, year; TC, serum total cholesterol; mo, month CVD, Cardiovascular disease.

Table 6 30-Yr Cardiovascular Risk Between Male and Female

	Baseline	3 Mo	12 Mo
30-year Full CVD (Lipid)
Overall	51.41 ± 20.81	35.04 ± 16.36*	20.00 (10.00, 39.00)*
Male	56.36 ± 18.01	37.88 ± 14.71*	22.00 (16.00, 34.00)*
Female	47.00 (23.00, 67.00)	32.41 ± 17.62*	14.50 (5.50, 44.50)*
P value	> 0.05	> 0.05	> 0.05
30-year Hard CVD (Lipid)
Overall	37.41 ± 19.86	19.00 (11.25, 29.50)*	12.00 (4.00, 19.50)*
Male	44.00 ± 18.69	23.00 (15.00, 32.00)*	13.00 (9.00, 19.00)*
Female	31.00 (13.00, 46.00)	13.00 (9.00, 28.00)*	6.50 (1.75, 20.25)*
P value	< 0.05	> 0.05	> 0.05
30-year Full CVD (BMI)
Overall	60.00 (40.50, 78.00)	37.40 ± 17.10*	29.00 ± 15.24*
Male	65.67 ± 16.31	44.41 ± 14.29*	33.93 ± 14.53*
Female	51.19 ± 23.95	26.00 (17.25, 42.50)*	19.00 (11.00, 36.00)*
P value	< 0.01	< 0.01	> 0.05
30-year Hard CVD (BMI)
Overall	46.05 ± 22.09	24.00 (14.00, 33.00)*	17.00 (8.50, 24.50)*
Male	55.27 ± 18.00	29.00 (21.00, 45.00)*	22.00 (15.00, 28.00)*
Female	37.13 ± 22.26	14.50 (8.25, 28.50)*	9.50 (5.75, 19.50)*
P value	< 0.01	< 0.01	< 0.05

Note: *P< 0.05 compared with baseline in patients.

Abbreviations: BMI, body mass index; yr, year; mo, month; CVD, Cardiovascular disease.

Table 7 10-Year Cardiovascular Risk of Different Modal Before and 1 Year After Surgery

	Baseline	12 Mo	Relative Risk Reduction
WHO risk model (TC)	8.00 (5.00, 13.50)	4.00 (2.00, 6.00)*	50%
WHO risk model (BMI)	5.00 (3.00, 9.50)	4.00 (3.00, 6.00)	20%
Global risk model (TC)	12.00 (6.50, 18.00)	3.00 (2.00, 7.50)*	75%
Global risk model (BMI)	7.00 (4.00, 11.00)	4.00 (2.00, 7.00)*	42.86%
Framingham Risk score (lipid)	11.80 (6.75, 19.35)	4.20 (1.35, 6.73)*	64.41%
Framingham Risk score (BMI)	14.50 (8.05, 24.00)	6.50 (3.20, 9.90)*	55.17%

Note: *P< 0.05 compared with baseline in patients.

Abbreviations: BMI, body mass index; yr, year; TC, serum total cholesterol; mo, month.