From Outcomes to Long‑Term Impact: Do Improvements in Individual Cardiometabolic Risk Factors After Sleeve Gastrectomy Translate to Reductions in Composite Indicators of Cardiovascular Risk?

Background: No previous research has assessed the long-term individual cardiometabolic risk factors and composite cardiovascular (CV) risk indicators in patients with obesity and type 2 diabetes (T2DM) after sleeve gastrectomy (SG). The current study undertook this task. Methods: This retrospective study examined patients with obesity and T2DM who underwent primary SG at our institution between 2011 and 2015 (N = 361). Individual risk factors included anthropometric, lipid, glycemic, and liver enzymes parameters; composite indicators included the proportion of patients meeting the American Diabetes Association (ADA) goals and the Framingham 10-year cardiovascular risk scores (FRS) at baseline and at 1, 3, 5, 7, and 9 years. Changes were evaluated using McNemar’s chi-square tests for repeated measures, linear mixed models with restricted maximum likelihood estimation, and split-plot analysis of variance (ANOVA) with post hoc pairwise comparisons. Results: SG considerably improved all individual cardiometabolic risk factors. The improvements were sustained over time except for the low-density lipoprotein and triglycerides levels which showed no significant change. Composite risk indicators also improved, where the proportion of patients achieving all three ADA goals significantly increased (from preop 0.46 to 5.52% at year 3). Similarly, the predicted cardiovascular risk was also significantly reduced. Categorized by sex, FRS reductions among females amounted to 23.88% at year 1, 28.91% at year 3, and 28.41% at year 5; in male patients, reductions were 19.79% at year 1, 20.69% at year 3, and 13.74% at year 5. By FRS risk groups, low-risk patients showed risk reductions of 14.55% at year 1, 6.67% at year 3, and 9.82% at year 5; medium-risk patients experienced reductions of 19.14% at year 1, 19.48% at year 3, and 19.89% at year 5; and high-risk patients experienced reductions of 24.71% at year 1, 32.01% at year 3, and 24.57% at year 5. High-risk patients showed two characteristics: (1) by timeframe, they obtained the greatest FRS reduction benefits at year 1 compared to other risk categories; and (2) they were the only patients to exhibit a remarkable downward shift in risk category, where their mean FRS decreased from being high-risk to moderate risk at year 3. Conclusions: SG provided sustained long-term cardiovascular benefits. Multiple individual risk factors including anthropometric, glycemic, lipid, blood pressure, and liver enzyme markers showed significant improvement. Composite CV risk indicators also improved. These changes in composite risk factors represent an aggregation of improvements in individual parameters, suggesting possible synergistic or additive interactions among them and highlighting their collective role in modulating overall cardiovascular health.