Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass in cardiovascular risk reduction: A match control study

Background: There is a paucity of studies comparing risk reduction of the atherosclerotic cardiovascular disease (ASCVD) and Framingham-body mass index (BMI) Coronary Heart risk score after a laparoscopic Roux-en-Y gastric bypass (RYGB), and few studies have assessed the efficacy of laparoscopic sleeve gastrectomy (SG) in reducing cardiovascular risk. Objective: Our goal in this study was to compare the impact of SG and RYGB on cardiovascular risk reduction. Setting: U.S. university hospital. Methods: We retrospectively reviewed the records of all SG or RYGB cases at our institution between 2010 and 2015. Patients who met the criteria for calculating the ASCVD 10-year and Framingham-BMI score were included in the study. Propensity score matching was used to match SG and RYGB on demographic characteristics and co-morbidities. Results: Of the 1330 bariatric patients reviewed in the study period, 219 (19.3%) patients met the criteria for risk score calculation. SG was the most prevalent surgery in 72.6% (N=159) of cases compared with RYGB in 27.4% (N=60) of cases. At 12-month follow-up, ASCVD 10-year score had an absolute risk reduction of 3.9 +/- 6.5% in SG patients and 2.9 +/- 5.8% in RYGB patients (P= .3). Framingham-BMI score absolute risk reduction was 11.0 +/- 12.0% in SG and 9.0 +/- 11.0% in RYGB patients (P= .4), and the decrease in estimated heart age was 12.1 +/- 15.6 years in SG versus 9.2 +/- 9.6 years in RYGB (P= .1). The percentage of estimated BMI loss at 1 year was 68.1 +/- 23.3% in SG versus 74.2 +/- 24.8% in RYGB (P=.1). Conclusion: Our results suggest that SG and RYGB are equally effective in improving cardiovascular risk and decreasing the estimated vascular/heart age at 12-month follow-up. (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.