The Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on adults with obesity and its Impact on Their Cardiovascular Risk Assessment Score in Abu Dhabi, United Arab Emirates

The Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on adults with obesity and its Impact on Their Cardiovascular Risk Assessment Score in Abu Dhabi, United Arab Emirates | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review The Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on adults with obesity and its Impact on Their Cardiovascular Risk Assessment Score in Abu Dhabi, United Arab Emirates Fatima Mohamed Al Mazrouei, Alyaa Ali Aal Mohamed, Aysha Saeed Al Nuaimi, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5983645/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND Obesity is a global health issue with significant public health implications. In addition, obesity plays a role in the development of obesity-related chronic illnesses like type 2 diabetes [T2DM], dyslipidemia, hypertension [HTN], and major adverse cardiovascular events [MACE]. Metabolic and bariatric surgery leads to significant and sustained weight loss and improves T2DM, HTN, dyslipidemia, and a lower rate of MACEs. OBJECTIVE To assess the impact of Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG] on Framingham risk score and the major modifiable cardiovascular risk factors including Type 2 Diabetes, dyslipidemia, and hypertension. MATERIALS AND METHODS A single-center retrospective cohort study, for all adult patients with obesity who underwent RYGB or SG at the Bariatric & Metabolic Institute (BMI Abu Dhabi) at Sheikh Khalifa Medical City (SKMC), United Arab Emirates (UAE) from January 2010 to December 2013. The cardiovascular risk score was calculated for 2 years before and 2 years after undergoing RYGB or SG for each patient. Electronic medical records were reviewed. All statistical analysis and data analysis were carried out using the R software, version 3.0.3 RESULTS During the study period, 363 adults with obesity underwent bariatric surgery at BMI Abu Dhabi (220 patients had Laparoscopic Roux-en Y gastric bypass (RYGB), 102 patients had Laparoscopic sleeve gastrectomy (SG), and 41 patients had other type of bariatric procedures). The overall risk reduction in cardiovascular risk score was 34.02% over 2 years from baseline. There was a significant reduction in the cardiovascular risk score in the first year after RYGB and SG followed by a plateau for the second year. Additionally, systolic blood pressure (SBP) improved by 9.02%, diastolic blood pressure (DBP) improved by 7.52%, and body mass index (BMI) improved by 39.93%. In addition, the total cholesterol, triglycerides, and low-density lipoprotein (LDL) levels declined by 9.07%, 29.98%, and 21.93% respectively. Furthermore, there was a considerable increase in high-density lipoprotein (HDL) levels of 35.65% over the same time, drop in glycated Hemoglobin (HbA1c) by 10.79%, drop in fasting blood glucose (FBS) by 10.30%, and drop in random blood glucose (RBG) by 15.55%. CONCLUSION A significant reduction in cardiovascular risk score after RYGB and SG was observed. In addition, RYGB and SG led to significant weight loss and improvement in other obesity-related medical conditions. cardiovascular risk score bariatric surgery Framingham risk score Type 2 Diabetes dyslipidemia and hypertension. Figures Figure 1 Figure 2 Introduction Cardiovascular diseases (CVDs) are the leading cause of death worldwide, with more people dying from CVDs each year than any other cause . 1 It is estimated that 17.5 million people died from CVDs in 2012, representing 31% of all global deaths. 1 In addition, data from the World Health Organization (WHO) in 2012 showed that the prevalence of non-communicable diseases (NCDs) including CVDs is 18.9% between ages 30 and 70 years. In 2014, the proportional mortality rate for both genders from CVDs was 30%. Beyond its impact on mortality, obesity has been suggested to be the main driver of increasing healthcare costs in many countries. 2 The United Arab Emirates [UAE] was established in 1971 and developed rapidly from a largely nomadic population to a modern and wealthy country with a Western lifestyle. This new Western lifestyle and urbanization exacerbated the burden of chronic diseases, particularly obesity-related cardiovascular risk. 3 In addition, type 2 diabetes, and cardiovascular disease were identified by the local Ministry of Health (MOH) as the leading cause of mortality in the UAE. 2 The prevalence of obesity in developed countries has nearly doubled since 1980. 3 As reported by the WHO obesity affects 32.7% of the UAE adult population. 4 It is an independent major risk factor for CVD, as well as contributes towards other known CVD risk factors, such as hypertension, dyslipidemia, and type 2 Diabetes. These risk factors are improved by losing weight, and the degree of improvement is frequently proportional to the amount of weight lost. Bariatric surgery complemented by lifestyle modification is associated with significant and sustained weight loss, which has made it the most effective approach in selected patients with severe obesity. 2 Although RYGB and SG lead to weight reduction and typically improve CVD risk factors, the long-term clinical impact of weight loss on CVD risk factors and outcomes after bariatric surgery is not well described. 5 Cardiovascular disease risk algorithms, including those developed within the Framingham Heart Study (FHS), may predict and reflect the clinical impact of obesity and weight loss. Framingham Risk Scores (FRS) of 10-year coronary heart diseases (CHD) are inversely proportional to the individual’s BMI and several studies have documented substantial reductions in 10-year CHD risk as soon as one year after bariatric surgery. However, none of these studies were conducted in the UAE. 5 No studies examined cardiovascular risk reduction after bariatric surgery in the UAE. OBJECTIVE: The present retrospective study aims to examine whether weight loss in adult patients with obesity after RYGB and SG would be associated with meaningful and sustainable reductions in their 10-year Framingham CVD risk scores. In addition, to determine the impact of RYGB and SG on the major modifiable cardiovascular risk factors including type 2 diabetes, dyslipidemia, and hypertension. METHODS The analysis in this article is based on pragmatically collected data and does not involve exposing any human or animal subjects to a new treatment by any of the authors. Subjects Patients’ recruitment was based on the electronic medical records (EMR) database of patients undergoing RYGB and SG at Sheikh Khalifa Medical City (SKMC), a tertiary hospital run by SEHA in the Emirate of Abu Dhabi, UAE. Adults with obesity (defined as ≥18 years of age, and BMI ≥ 35 kg/m 2 respectively) who RYGB or SG during the study period (between Jan 2010 – Dec 2013) were included in the study regardless of their nationality (UAE nationals and non-nationals). A total sample of 400 patients out of 530 was randomly selected using a computer-generated sequence. For improving precision this is double the calculated sample size, which was 199 for a power of 80%, two-tailed alpha of 0.05, a change in Framingham score of 1% in the subjects, and a standard deviation of 2. After reviewing the EMR, 37 patients with revision bariatric procedures and/or missing data were excluded. The closing sample size was 363 patients who were analyzed. Written informed consent was obtained at the time of the preoperative visit. The study was approved by the Research and Ethics committees of Sheikh Khalifa Medical City, Al Ain Medical District, as well as The College of Medicine & Health Sciences, UAE University, Abu Dhabi. The study was conducted in accordance with the principles of the Declaration of Helsinki. Study Design: Retrospective cohort study. Outcome measures The baseline measures were taken during the initial preoperative period and incorporated: Sociodemographic parameters: including age, gender, and nationality; anthropometric data compromising weight, height, BMI (calculated as weight [Kg] / height [m 2 ]); systolic and diastolic blood pressure (as measured using a standard sphygmomanometer equipped with an appropriate cuff size); metabolic marker outcomes, including lipid profile (total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides), fasting blood glucose, random blood glucose, glycated-hemoglobin (HbA1c); history of Type 2 Diabetes, anti-glycemic medications, hypertension history, anti-hypertensive medications, dyslipidemia history, other comorbidities, smoking history and family history of cardiovascular diseases (CVDs), as well as the type of bariatric procedure performed. All measures were followed up postoperatively at intervals of 6, 12, and 24 months. The collected data was interpreted as follows. The estimated risk of developing coronary heart disease in the subsequent 10 years was calculated using the Framingham risk score (FRS), weight loss was determined by BMI (patient’s weight in kilograms divided by the square of height in meters) 6 type 2 diabetes was concluded using the American Diabetes Association’s 7 definition of type 2 diabetes (HbA1c ≥6.5% or fasting blood glucose ≥7 mmol/L), hypertension defined as blood pressure of 140/90 or more 8 whereas Dyslipidemia was defined as total cholesterol of more than 200 mg/dl, LDL of more than 100 mg/dl, HDL of less than 40 mg/dl, and triglyceride of more than 150 mg/dl. 9 Pilot validation of the data collection sheet was completed initially on randomly selected medical records of 10 patients from among the sample studied. Statistical methods The main objective of the paper is to investigate the longitudinal pattern of the 10-year CVD risk score in patients who underwent bariatric surgery between the years 2010 and 2013. The data consisted of repeated measures of traditional risk factors for CVD evaluated at baseline, 6, 12, and 24 months after the surgery. All statistical analysis and data manipulation were carried out using the R software, version 3.0.3. 10 Data was first checked for outliers using a function implemented in the R software. Outliers were either corrected or deleted. The percentage of missing data per visit and for each variable was also calculated and reported. 11 The Framingham 10-year risk score for hard coronary heart diseases (CHD) suggested in the ATP 3 was used in this paper. 12 This risk score uses age, HDL, total cholesterol, smoking history, and systolic blood pressure as input risk factors in order to predict the 10-year risk for hard CHD (CV death or nonfatal MI). The equations of the model were implemented in a function through the R software. Qualitative data were presented using counts and percentages, while quantitative data were presented using mean ± Standard Deviation (SD). A Paired T-test was used to compare the following variables (Total Cholesterol, HDL, LDL, triglyceride, HBA1c, fasting blood sugar, random blood sugar, systolic blood pressure, diastolic blood pressure, body mass index, and Framingham risk score) over 2 years before and after RYRGB and SG. A p-value of ≤0.05 (two-sided) was used to indicate statistical significance. RESULTS A total of 363 patients underwent bariatric surgeries (220 patients had RYGB, 102 patients had SG, and 41 patients had other types of bariatric procedures); of these, approximately two-thirds (67.4%) were women, and one-third (32.6 %) were men. Table 1 shows the baseline characteristics of the studied patients. The average pre-operative BMI was 46.52 Kg/m2. Out of the studied population, nearly one-fourth (24.8%) had type 2 Diabetes, and one-fifth (21.6%) had HTN and were on antihypertensive medications. Furthermore, 17% of the total patients were smokers. The averages of the metabolic profiles including total cholesterol; LDL; triglycerides; HDL; and HbA1c were 183.1 mg/dl; 2.95 mmol/L; 1.4 mmol/L; 44.2 mg/dl; and 6.1 % respectively. (Table1) The paired T-test comparison between cardiovascular risk variables over 2 years before and after RYRGB and SG is shown in Table 2. We found that there was a statistically significant difference between total cholesterol, HDL, LDL, and triglycerides over 2 years before and after RYRGB and SG (mean differences: (16.60), (-15.76), (0.65), (0.41) respectively with P<0.001). Also, a significant difference was found in the comparison of HBA1c, fasting blood glucose, and random blood glucose over 2 years before and after RYRGB and SG (mean differences :(0.65), (0.58), and (0.91) respectively with P<0.001). Moreover, there was a significant difference found in systolic blood pressure, diastolic blood pressure, and body mass index preoperatively and 2 years postoperatively (mean differences :(11.53), (5.61), and (15.31) respectively with P<0.001). For the Framingham risk score there was as well significant difference over 2 years before and after RYRGB and SG (mean differences: 0.91; P<0.001). (Table 2) Figure 1 represents the overall change in Framingham risk score in patients over 2 years before and after RYGB and SG. Overall, there is a 34.02 % reduction in Framingham risk score postoperatively (P < 0.001). After the initial reduction in Framingham risk score, there was a plateau after 1 year after RYGB and SG until 2 years. Figure 2 shows participants' lipid profile change over 2 years before and after RYRGB and SG. As noted, the total cholesterol, triglycerides, and LDL levels significantly declined by 9.07 %, 29.98 %, and 21.93 % respectively (P<0.001). On the other hand, there is a significant improvement of HDL level by 35.65% over the same period (P<0.001). Figure 3 also shows a change in the blood glucose profiles of the participants over the period of two years, before and after undergoing bariatric surgery. Overall, the longitudinal blood glucose profiles markedly declined from the baseline. In total, HbA1c decreased by 10.79 %, FBS by 10.30 %, and Random blood glucose (RBG) by 15.55% with significant P value (P<0.001). In addition, there is a similar improvement in the clinical profile measures with a conclusive decrease in the SBP by 9.02 %, DBP by 7.52 %, and BMI by 39.93 % (P<0.001). DISCUSSION This is the first study to examine cardiovascular risk reduction after RYGB and SG in the United Arab Emirates. Cardiovascular disease is a global health problem with high prevalence in the UAE population leading to a significant rate of morbidity and mortality. Our study showed a dramatic 34% reduction in the Framingham risk score after RYGB and SG. Initially, there was a significant steady decline in the Framingham risk score from baseline for the first 12 months, followed by a plateau for the second year. As mentioned previously, Our results are similar to several international studies. 13–15 A systematic review done by Cleveland clinic in 2011, showed a 40% cardiovascular relative risk reduction for 10 years of coronary heart disease risk after bariatric surgery. 16 Our study also showed a significant improvement in type 2 diabetes, hyperlipidemia, and hypertension in patients undergoing RYGB and SG similar to several other studies. 4, 16 19,20 A meta-analysis and meta-regression study with 5-years follow-up conducted in 2014 showed that the risk of type 2 diabetes, hypertension, and hyperlipidemia decreased after bariatric surgery, with relative risks of 0.33 (95 % CI=0.26–0.41; I2=42 %), 0.54 (95 % CI=0.46–0.64; I2=68 %) and 0.33 (95 % CI=0.22–0.46; I2= 74 %) respectively. 3 In addition, Hypertension risk reached a minimum when the BMI fell 10 units and the risks of all cardiovascular outcomes reached a plateau, 20–40 months after bariatric surgery. 3 The mechanism of improvement in type 2 Diabetes is not only through decreased caloric intake but rather through multiple mechanisms that contribute to the dramatic improvement of type 2 diabetes after bariatric surgeries that alter gastrointestinal anatomy. The mechanisms include an increase in levels of glucagon-like peptide-1 and peptide YY, which are secreted by intestinal L cells, enhance insulin secretion, increase satiety, and delay gastric emptying through receptors in the central and peripheral nervous systems. Moreover, Ghrelin, which is secreted primarily by the gastric fundus and proximal small intestine, acts via the hypothalamus to stimulate appetite and suppress energy expenditure and fat catabolism. 19 Significant and sustained weight loss augments type 2 Diabetes resolution. For example, Roux-en-Y gastric bypass seems which lead to a slightly greater weight loss during the first two postsurgical years, followed by sleeve gastrectomy and laparoscopic adjustable gastric banding. Remission of type 2 diabetes occurs in 60% to 80% of Roux-en-Y gastric bypass patients at one to two years post-surgery. Recent longer-term studies indicate that this remission is retained in approximately 40% of patients at 10 years and 30% at 15 years. 19 Our study did not compare RHGB and SG. Hence, a better understanding of the mechanisms of action of each procedure is required. Further research on bariatric surgical procedures is needed to define the benefits of weight loss on various comorbidities of obesity such as type 2 diabetes, metabolic syndrome, dyslipidemia, polycystic ovary syndrome, and obstructive sleep apnea. We need to know more about who should be offered bariatric surgery and define the safest and most efficient pathways for assessment, surgery, and aftercare. Bariatric surgery has the potential to be one of the most important and powerful treatment approaches in medicine. High-quality clinical care, good science, and comprehensive data management will allow optimal application of this approach to be realized. STRENGTHS AND LIMITATIONS: To the best of our knowledge, this is one of the first studies conducted in the UAE to study the association between bariatric surgeries and cardiovascular risk scores. It has examined the effect of bariatric procedures on multiple risk factors including type 2 diabetes, hypertension, hyperlipidemia, as well as the reduction in BMI. Additionally, the studied sample size was carefully calculated to be representative of the target population especially that the Emirate of Abu Dhabi serves as the hub of healthcare in the UAE. On the other hand, like any other research, this study has some limitations. First of all, potential confounders were not properly accounted for due to the study type including data on lifestyle changes or pharmacologic interventions beyond those used for hypertension and diabetes management (contamination and co-intervention bias). Secondly, the data were retrieved retrospectively; therefore, inaccuracies in data collection were inevitable. However, the data were collected from patients recruited in a well-known, evidence-based, and non-private bariatric program, where trained healthcare personnel are regularly monitored and are very likely to have accurate data entries and proper counseling. Furthermore, the electronically generated reports were limited to patients attending a single but major governmental hospital, and private institutions were not included. Thereupon, this study did not assess the bariatric procedures taking place in private hospitals. By the same token, missing data was a challenging factor in data analysis. Thus, a multicenter prospective cohort study with a longer follow-up period is required to clarify most of the factors that remain unclear. Over and above that, this study involved a multi-national population group with different ethnic races, which helps in the generalizability of the results. However, further studies are needed to focus on the UAE nationals in order to be able to formulate a risk assessment tool that is more suitable and applicable to the local population. Finally, this study did not look into the complications of bariatric procedures, both short and long-term. These factors can be added in future studies because their clarification can have a major effect on the overall outcome of bariatric procedures and their risks-benefits balance. CONCLUSION Roux-en-Y gastric bypass and SG resulted in a major improvement in the Framingham Risk cardiovascular risk score and significant weight loss and improvement in Type 2 Diabetes, hypertension, and dyslipidemia. Larger and long-term studies are needed to further document whether the effects of bariatric procedures on weight loss and CVD risk factors translate into reduced CVD incidence. Abbreviations BMI Abu Dhabi: Bariatric & Metabolic Institute Abu Dhabi SKMC: Sheikh Khalifa Medical City RYGB: Roux-en-Y gastric bypass SG: Sleeve Gastrectomy T2DM: Type 2 Diabetes HTN: Hypertension MACE: Major Adverse Cardiovascular Events LDL: Low-Density Lipoprotein HDL: High-Density Lipoprotein FBS: Fasting Blood Glucose RBG: Random Blood Glucose SBP: Systolic Blood Pressure DBP: Diastolic Blood Pressure BMI: Body Mass Index CVDs: Cardiovascular Disease WHO: World Health Organization NCD: Non-Communicable Diseases MOH: Ministry of Health FHS: Framingham Heart Study FRS: Framingham Risk Scores CHD: Coronary Heart Diseases EMR: Electronic medical records MICE: Multivariate Imputation by Chained Equations ATP 3: Adult Treatment Panel III UAE: United Arab Emirates Declarations Ethics approval and consent to participate The study was approved by the Research and Ethics committees of Sheikh Khalifa Medical City, Al Ain Medical District, as well as The College of Medicine & Health Sciences, UAE University, Abu Dhabi. Written informed consent was obtained at the time of the preoperative visit. The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The data are restricted and cannot be shared publicly as it is owned by the institution (Sheikh Khalifa Medical City). All Relevant data are included in this published article. If any additional data/files are required may be obtained from the corresponding author. Competing interests The authors declare that they have no competing interests. Funding No funding Authors' contributions All authors contributed to the concept, design of the study, read and approved the final manuscript. FMA, AAM, ASA, RZA, and DMA Participated in the acquisition of data, statistical analysis, interpretation of data, editing, drafting of the manuscript, and revising it critically for important intellectual content. AAA, FA, and AN participated in the interpretation of data, editing, drafting of the manuscript and revising it critically for important intellectual content. Acknowledgements SKMC administration for facilitating data collection [ Dr Fawaz Torab] passed away before the submission of the final version of this manuscript. [Amal Abdul Rahim Al Zarooni] accepts responsibility for the integrity and validity of the data collected and analyzed. References Cardiovascular diseases (CVDs). Accessed November 1, 2021. https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) search results - World Health Organization . (2014, july). Noncommunicable Diseases (NCD) Country Profiles. Retrieved from World Health Organization : http://apps.who.int/iris/bitstream/10665/128038/1/9789241507509_eng.pdf. 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Accessed November 1, 2021. https://reference.medscape.com/calculator/253/framingham-risk-score-atp-iii Vest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. Heart . 2012;98(24):1763-1777. doi:10.1136/heartjnl-2012-301778 Batsis JA, Miranda WR, Prasad C, et al. Effect of bariatric surgery on cardiometabolic risk in elderly patients: A population-based study: Bariatric surgery and older adults. Geriatr Gerontol Int . 2016;16(5):618-624. doi:10.1111/ggi.12527 Batsis JA, Sarr MG, Collazo-Clavell ML, et al. Cardiovascular Risk After Bariatric Surgery for Obesity. Am J Cardiol . 2008;102(7):930-937. doi:10.1016/j.amjcard.2008.05.040 Heneghan HM, Meron-Eldar S, Brethauer SA, Schauer PR, Young JB. Effect of Bariatric Surgery on Cardiovascular Risk Profile†Drs. Heneghan and Meron-Eldar contributed equally to this article. Am J Cardiol . 2011;108(10):1499-1507. doi:10.1016/j.amjcard.2011.06.076 Owen JG, Yazdi F, Reisin E. Bariatric Surgery and Hypertension. Am J Hypertens . 2018;31(1):11-17. doi:10.1093/ajh/hpx112 Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery: A Systematic Review and Meta-analysis. JAMA . 2004;292(14):1724. doi:10.1001/jama.292.14.1724 Schroeder R, Harrison TD. Treatment of Adult Obesity with Bariatric Surgery. Bariatr Surg . 2016;93(1):7. Tables Tables 1 to 2 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Bariatrictabelonly.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5983645","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":416875109,"identity":"d05ae137-ad64-4f3e-b3cb-9ad4e4ec4794","order_by":0,"name":"Fatima Mohamed Al Mazrouei","email":"","orcid":"","institution":"Ambulatory Healthcare Services, Abu Dhabi Health Services Company","correspondingAuthor":false,"prefix":"","firstName":"Fatima","middleName":"Mohamed Al","lastName":"Mazrouei","suffix":""},{"id":416875110,"identity":"d6df2a30-a2b9-44e5-bae8-7c0c88e40a26","order_by":1,"name":"Alyaa Ali Aal 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Company","correspondingAuthor":true,"prefix":"","firstName":"Amal","middleName":"Abdul Rahim","lastName":"ALZAROONI","suffix":""},{"id":416875115,"identity":"816cb36f-0e4d-4f90-b4df-9a829018e574","order_by":6,"name":"Fatima Al Maskari","email":"","orcid":"","institution":"Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Fatima","middleName":"Al","lastName":"Maskari","suffix":""},{"id":416875116,"identity":"3bf64e97-1963-44cd-acbd-b6104699891c","order_by":7,"name":"Fawaz Torab","email":"","orcid":"","institution":"Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University","correspondingAuthor":false,"prefix":"","firstName":"Fawaz","middleName":"","lastName":"Torab","suffix":""},{"id":416875117,"identity":"e7cfd35b-c092-4a9b-ba00-71dbaa7e0276","order_by":8,"name":"Abdelrahman Nimeri","email":"","orcid":"","institution":"Director Bariatric \u0026 Metabolic Surgery ,Brigham and Women’s Hospital Associate Professor of Surgery ,Harvard Medical School","correspondingAuthor":false,"prefix":"","firstName":"Abdelrahman","middleName":"","lastName":"Nimeri","suffix":""}],"badges":[],"createdAt":"2025-02-07 20:08:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5983645/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5983645/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76875186,"identity":"09ab8398-c0d0-41ee-ac8a-a58ef55c003f","added_by":"auto","created_at":"2025-02-21 16:04:09","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46685,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure1bariatric.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5983645/v1/c82ff896ab954e04b7f386e4.jpg"},{"id":76873554,"identity":"67b4f62e-55ee-45cb-8dd5-7ec0a41237b7","added_by":"auto","created_at":"2025-02-21 15:48:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":89815,"visible":true,"origin":"","legend":"\u003cp\u003eFigure3. See image above for figure legend.\u003c/p\u003e","description":"","filename":"bariatricfigure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5983645/v1/140acb2530835527fdd77a91.jpg"},{"id":76875188,"identity":"6244177e-9ecc-46a1-9f47-672ced41c96b","added_by":"auto","created_at":"2025-02-21 16:04:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":740246,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5983645/v1/eb84ae2d-1c66-4b43-bce8-70ff71ce5e79.pdf"},{"id":76874500,"identity":"f5012b77-a129-4b21-907e-2df82a2d2683","added_by":"auto","created_at":"2025-02-21 15:56:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20455,"visible":true,"origin":"","legend":"","description":"","filename":"Bariatrictabelonly.docx","url":"https://assets-eu.researchsquare.com/files/rs-5983645/v1/18722429feb0b29abab9d909.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on adults with obesity and its Impact on Their Cardiovascular Risk Assessment Score in Abu Dhabi, United Arab Emirates\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiovascular diseases (CVDs) are the leading cause of death worldwide, with more people dying from CVDs each year than any other cause\u003cstrong\u003e.\u003c/strong\u003e\u003csup\u003e1\u003c/sup\u003eIt is estimated that 17.5 million people died from CVDs in 2012, representing 31% of all global deaths.\u003csup\u003e1\u003c/sup\u003e In addition,\u0026nbsp;data from the World Health Organization (WHO) in 2012 showed that the prevalence of non-communicable diseases (NCDs) including CVDs is 18.9% between ages 30 and 70 years. In 2014, the proportional mortality rate for both genders from CVDs was 30%.\u0026nbsp;Beyond its impact on mortality, obesity has been suggested to be the main driver of increasing healthcare costs in many countries.\u003csup\u003e\u0026nbsp;2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe United Arab Emirates [UAE] was established in 1971 and developed rapidly from a largely nomadic population to a modern and wealthy country with a Western lifestyle. This new Western lifestyle and urbanization exacerbated the burden of chronic diseases, particularly obesity-related cardiovascular risk. \u003csup\u003e3\u003c/sup\u003e In addition, type 2 diabetes, and cardiovascular disease were identified by the local Ministry of Health (MOH) as the leading cause of mortality in the UAE.\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of obesity in developed countries has nearly doubled since 1980.\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAs reported by the WHO obesity affects 32.7% of the UAE adult population.\u003csup\u003e4\u003c/sup\u003e It is an independent major risk factor for CVD, as well as contributes towards other known CVD risk factors, such as hypertension, dyslipidemia, and type 2 Diabetes. These risk factors are improved by losing weight, and the degree of improvement is frequently proportional to the amount of weight lost. Bariatric surgery complemented by lifestyle modification is associated with significant and sustained weight loss, which has made it the most effective approach in selected patients with severe obesity.\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAlthough RYGB and SG lead to weight reduction and typically improve CVD risk factors, the long-term clinical impact of weight loss on CVD risk factors and outcomes after bariatric surgery is not well described.\u0026nbsp;\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eCardiovascular disease risk algorithms, including those developed within the Framingham Heart Study (FHS), may predict and reflect the clinical impact of obesity and weight loss. Framingham Risk Scores (FRS) of 10-year coronary heart diseases (CHD) are inversely proportional to the individual’s BMI and several studies have documented substantial reductions in 10-year CHD risk as soon as one year after bariatric surgery. However, none of these studies were conducted in the UAE.\u0026nbsp;\u003csup\u003e5\u003c/sup\u003e No studies examined cardiovascular risk reduction after bariatric surgery in the UAE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOBJECTIVE:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present retrospective study aims to examine whether weight loss in adult patients with obesity after RYGB and SG would be associated with meaningful and sustainable reductions in their 10-year Framingham CVD risk scores. In addition, to determine the impact of RYGB and SG on the major modifiable cardiovascular risk factors including type 2 diabetes, dyslipidemia, and hypertension.\u0026nbsp;\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe analysis in this article is based on pragmatically collected data and does not involve exposing any human or animal subjects to a new treatment by any of the authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubjects\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients\u0026rsquo; recruitment was based on the electronic medical records (EMR) database of patients undergoing RYGB and SG at Sheikh Khalifa Medical City (SKMC), a tertiary hospital run by SEHA in the Emirate of Abu Dhabi, UAE. Adults with obesity (defined as \u0026ge;18 years of age, and BMI \u0026ge; 35 kg/m\u003csup\u003e2\u003c/sup\u003e respectively) who RYGB or SG during the study period (between Jan 2010 \u0026ndash; Dec 2013) were included in the study regardless of their nationality (UAE nationals and non-nationals). A total sample of 400 patients out of 530 was randomly selected using a computer-generated sequence. For improving precision this is double the calculated sample size, which was 199 for a power of 80%, two-tailed alpha of 0.05, a change in Framingham score of 1% in the subjects, and a standard deviation of 2. After reviewing the EMR, 37 patients with revision bariatric procedures and/or missing data were excluded. The closing sample size was 363 patients who were analyzed. Written informed consent was obtained at the time of the preoperative visit.\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Research and Ethics committees of Sheikh Khalifa Medical City, Al Ain Medical District, as well as The College of Medicine \u0026amp; Health Sciences, UAE University, Abu Dhabi. The study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design:\u0026nbsp;\u003c/strong\u003eRetrospective cohort study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measures\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe baseline measures were taken during the initial preoperative period and incorporated: Sociodemographic parameters: including age, gender, and nationality; anthropometric data compromising weight, height, BMI (calculated as weight [Kg] / height [m\u003csup\u003e2\u003c/sup\u003e]); systolic and diastolic blood pressure (as measured using a standard sphygmomanometer equipped with an appropriate cuff size); metabolic marker outcomes, including lipid profile (total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides), fasting blood glucose, random blood glucose, glycated-hemoglobin (HbA1c); history of Type 2 Diabetes, anti-glycemic medications, hypertension history, anti-hypertensive medications, dyslipidemia history, other comorbidities, \u0026nbsp; smoking history and family history of cardiovascular diseases (CVDs), as well as the type of bariatric procedure performed. All measures were followed up postoperatively at intervals of 6, 12, and 24 months.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe collected data was interpreted as follows. The estimated risk of developing coronary heart disease in the subsequent 10 years was calculated using the Framingham risk score (FRS), weight loss was determined by BMI (patient\u0026rsquo;s weight in kilograms divided by the square of height in meters)\u003csup\u003e6\u003c/sup\u003e type 2 diabetes was concluded using the American Diabetes Association\u0026rsquo;s \u003csup\u003e7\u003c/sup\u003e definition of type 2 diabetes (HbA1c \u0026ge;6.5% or fasting blood glucose \u0026ge;7 mmol/L), hypertension defined as blood pressure of 140/90 or more \u003csup\u003e8\u003c/sup\u003e whereas Dyslipidemia was defined as total cholesterol of more than 200 mg/dl, LDL of more than 100 mg/dl, HDL of less than 40 mg/dl, and triglyceride of more than 150 mg/dl.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ePilot validation of the data collection sheet was completed initially on randomly selected medical records of 10 patients from among the sample studied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main objective of the paper is to investigate the longitudinal pattern of the 10-year CVD risk score in patients who underwent bariatric surgery between the years 2010 and 2013. The data consisted of repeated measures of traditional risk factors for CVD evaluated at baseline, 6, 12, and 24 months after the surgery. All statistical analysis and data manipulation were carried out using the R software, version 3.0.3. \u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eData was first checked for outliers using a function implemented in the R software. Outliers were either corrected or deleted. The percentage of missing data per visit and for each variable was also calculated and reported. \u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe Framingham 10-year risk score for hard coronary heart diseases (CHD) suggested in the ATP 3\u0026nbsp;was used in this paper.\u003csup\u003e12\u003c/sup\u003e This risk score uses age, HDL, total cholesterol, smoking history, and systolic blood pressure as input risk factors in order to predict the 10-year risk for hard CHD (CV death or nonfatal MI). The equations of the model were implemented in a function through the R software.\u003c/p\u003e\n\u003cp\u003eQualitative data were presented using counts and percentages, while quantitative data were presented using mean \u0026plusmn; Standard Deviation (SD). A Paired T-test was used to compare the following variables (Total Cholesterol, HDL, LDL, triglyceride, HBA1c, fasting blood sugar, random blood sugar, systolic blood pressure, diastolic blood pressure, body mass index, and Framingham risk score) over 2 years before and after RYRGB and SG. A p-value of \u0026le;0.05 (two-sided) was used to indicate statistical significance.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 363 patients underwent bariatric surgeries (220 patients had RYGB, 102 patients had SG, and 41 patients had other types of bariatric procedures); of these, approximately two-thirds (67.4%) were women, and one-third (32.6 %) were men. Table 1 shows the baseline characteristics of the studied patients. The average pre-operative BMI was 46.52 Kg/m2. Out of the studied population, nearly one-fourth (24.8%) had type 2 Diabetes, and one-fifth (21.6%) had HTN and were on antihypertensive medications. Furthermore, 17% of the total patients were smokers. The averages of the metabolic profiles including total cholesterol; LDL; triglycerides; HDL; and HbA1c were 183.1 mg/dl; 2.95 mmol/L; 1.4 mmol/L; 44.2 mg/dl; and 6.1 % respectively. (Table1)\u003c/p\u003e\n\u003cp\u003eThe paired T-test comparison between cardiovascular risk variables over 2 years before and after RYRGB and SG is shown in Table 2. We found that there was a statistically significant difference between total cholesterol, HDL, LDL, and triglycerides over 2 years before and after RYRGB and SG (mean differences: (16.60), (-15.76), (0.65), (0.41) respectively with P\u0026lt;0.001). Also, a significant difference was found in the comparison of HBA1c, fasting blood glucose, and random blood glucose over 2 years before and after RYRGB and SG (mean differences :(0.65), (0.58), and (0.91) respectively with P\u0026lt;0.001). Moreover, there was a significant difference found in systolic blood pressure, diastolic blood pressure, and body mass index preoperatively and 2 years postoperatively (mean differences :(11.53), (5.61), and (15.31) respectively with P\u0026lt;0.001). For the\u0026nbsp;Framingham risk score there was as well significant difference over 2 years before and after RYRGB and SG (mean differences: 0.91; P\u0026lt;0.001). (Table 2)\u003c/p\u003e\n\u003cp\u003eFigure 1 represents the overall change in Framingham risk score in patients over 2 years before and after RYGB and SG. Overall, there is a 34.02 % reduction in\u0026nbsp;Framingham\u0026nbsp;risk score postoperatively (P \u0026lt; 0.001). After the initial reduction in\u0026nbsp;Framingham\u0026nbsp;risk score, there was a plateau after 1 year after RYGB and SG until 2 years.\u003c/p\u003e\n\u003cp\u003eFigure 2 shows participants' lipid profile change over 2 years before and after RYRGB and SG. As noted, the total cholesterol, triglycerides, and LDL levels significantly declined by 9.07 %, 29.98 %, and 21.93 % respectively (P\u0026lt;0.001). On the other hand, there is a significant improvement of HDL level by 35.65% over the same period (P\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 3 also shows a change in the blood glucose profiles of the participants over the period of two years, before and after undergoing bariatric surgery. Overall, the longitudinal blood glucose profiles markedly declined from the baseline. In total, HbA1c decreased by 10.79 %, FBS by 10.30 %, and Random blood glucose (RBG) by 15.55% with significant P value (P\u0026lt;0.001). In addition, there is a similar improvement in the clinical profile measures with a conclusive decrease in the SBP by 9.02 %, DBP by 7.52 %, and BMI by 39.93 % (P\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis is the first study to examine cardiovascular risk reduction after RYGB and SG in the United Arab Emirates. Cardiovascular disease is a global health problem with high prevalence in the UAE population leading to a significant rate of morbidity and mortality. Our study showed a dramatic 34% reduction in the Framingham risk score after RYGB and SG. Initially, there was a significant steady decline in the Framingham risk score from baseline for the first 12 months, followed by a plateau for the second year. As mentioned previously, Our results are similar to several international studies.\u003csup\u003e13–15\u003c/sup\u003e A systematic review done by Cleveland clinic in 2011, showed a 40% cardiovascular relative risk reduction for 10 years of coronary heart disease risk after bariatric surgery.\u0026nbsp;\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Our study also showed a significant improvement in type 2 diabetes, hyperlipidemia, and hypertension in patients undergoing RYGB and SG similar to several other studies.\u003csup\u003e4,\u003c/sup\u003e \u003csup\u003e16\u003c/sup\u003e \u003csup\u003e19,20\u003c/sup\u003e A\u0026nbsp;meta-analysis and meta-regression study with 5-years follow-up conducted in 2014 showed that the risk of type 2 diabetes, hypertension, and hyperlipidemia decreased after bariatric surgery, with relative risks of 0.33 (95 % CI=0.26–0.41; I2=42 %), 0.54 (95 % CI=0.46–0.64; I2=68 %) and 0.33 (95 % CI=0.22–0.46; I2= 74 %) respectively.\u003csup\u003e3\u003c/sup\u003e In addition, Hypertension risk reached a minimum when the BMI fell 10 units and the risks of all cardiovascular outcomes reached a plateau, 20–40 months after bariatric surgery.\u003csup\u003e3\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mechanism of improvement in type 2 Diabetes is not only through decreased caloric intake but rather through multiple mechanisms that contribute to the dramatic improvement of type 2 diabetes after bariatric surgeries that alter gastrointestinal anatomy. The mechanisms include an increase in levels of glucagon-like peptide-1 and peptide YY, which are secreted by intestinal L cells, enhance insulin secretion, increase satiety, and delay gastric emptying through receptors in the central and peripheral nervous systems. Moreover, Ghrelin, which is secreted primarily by the gastric fundus and proximal small intestine, acts via the hypothalamus to stimulate appetite and suppress energy expenditure and fat catabolism.\u0026nbsp;\u003csup\u003e19\u003c/sup\u003e Significant and sustained weight loss augments type 2 Diabetes resolution. For example, Roux-en-Y gastric bypass seems which lead to a slightly greater weight loss during the first two postsurgical years, followed by sleeve gastrectomy and laparoscopic adjustable gastric banding. Remission of type 2 diabetes occurs in 60% to 80% of Roux-en-Y gastric bypass patients at one to two years post-surgery. Recent longer-term studies indicate that this remission is retained in approximately 40% of patients at 10 years and 30% at 15 years.\u0026nbsp;\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eOur study did not compare RHGB and SG. Hence, a better understanding of the mechanisms of action of each procedure is required. Further research on bariatric surgical procedures is needed to define the benefits of weight loss on various comorbidities of obesity such as type 2 diabetes, metabolic syndrome, dyslipidemia, polycystic ovary syndrome, and obstructive sleep apnea. We need to know more about who should be offered bariatric surgery and define the safest and most efficient pathways for assessment, surgery, and aftercare.\u003c/p\u003e\n\u003cp\u003eBariatric surgery has the potential to be one of the most important and powerful treatment approaches in medicine. High-quality clinical care, good science, and comprehensive data management will allow optimal application of this approach to be realized.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTRENGTHS AND LIMITATIONS:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, this is one of the first studies conducted in the UAE to study the association between bariatric surgeries and cardiovascular risk scores. It has examined the effect of bariatric procedures on multiple risk factors including type 2 diabetes, hypertension, hyperlipidemia, as well as the reduction in BMI. Additionally, the studied sample size was carefully calculated to be representative of the target population especially that the Emirate of Abu Dhabi serves as the hub of healthcare in the UAE.\u003c/p\u003e\n\u003cp\u003eOn the other hand, like any other research, this\u0026nbsp;study has some limitations. First of all,\u0026nbsp;potential confounders were not properly accounted for due to the study type including\u0026nbsp;data on lifestyle changes or pharmacologic interventions beyond those used for hypertension and diabetes management (contamination and co-intervention bias). Secondly, the data were retrieved retrospectively; therefore, inaccuracies in data collection were inevitable. However, the data were collected from patients recruited in a well-known, evidence-based, and non-private bariatric program, where trained healthcare personnel are regularly monitored and are very likely to have accurate data entries and proper counseling.\u003c/p\u003e\n\u003cp\u003eFurthermore, the electronically generated reports were limited to patients attending a single but major governmental hospital, and\u0026nbsp;private institutions were not included. Thereupon, this study did not assess the bariatric procedures taking place in private hospitals. By the same token, missing data was a challenging factor in data analysis. Thus, a multicenter prospective cohort study with a longer follow-up period is required to clarify most of the factors that remain unclear.\u003c/p\u003e\n\u003cp\u003eOver and above that, this study involved a multi-national population group with different ethnic races, which helps in the generalizability of the results. However, further studies are needed to focus on the UAE nationals in order to be able to formulate a risk assessment tool that is more suitable and applicable to the local population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally,\u0026nbsp;this study did not look into the complications of bariatric procedures, both short and long-term. These factors can be added in future studies because their clarification can have a major effect on the overall outcome of bariatric procedures and their risks-benefits balance.\u003c/p\u003e"},{"header":"CONCLUSION ","content":"\u003cp\u003eRoux-en-Y gastric bypass and SG resulted in a major improvement in the Framingham Risk cardiovascular risk score and significant weight loss and improvement in Type 2 Diabetes, hypertension, and dyslipidemia. Larger and long-term studies are needed to further document whether the effects of bariatric procedures on weight loss and CVD risk factors translate into reduced CVD incidence.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI Abu Dhabi: Bariatric \u0026amp; Metabolic Institute Abu Dhabi\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSKMC: Sheikh Khalifa Medical City\u003c/p\u003e\n\u003cp\u003eRYGB: Roux-en-Y gastric bypass\u003c/p\u003e\n\u003cp\u003eSG: \u0026nbsp;Sleeve Gastrectomy\u003c/p\u003e\n\u003cp\u003eT2DM: Type 2 Diabetes\u003c/p\u003e\n\u003cp\u003eHTN: Hypertension\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMACE: Major Adverse Cardiovascular Events\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLDL: Low-Density Lipoprotein\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHDL: High-Density Lipoprotein\u003c/p\u003e\n\u003cp\u003eFBS: Fasting Blood Glucose\u003c/p\u003e\n\u003cp\u003eRBG: Random Blood Glucose\u003c/p\u003e\n\u003cp\u003eSBP: Systolic Blood Pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDBP: Diastolic Blood Pressure\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCVDs: Cardiovascular Disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNCD: Non-Communicable Diseases\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;MOH: Ministry of Health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFHS: Framingham Heart Study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFRS: Framingham Risk Scores\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCHD: Coronary Heart Diseases\u003c/p\u003e\n\u003cp\u003eEMR: Electronic medical records\u003c/p\u003e\n\u003cp\u003eMICE: Multivariate Imputation by Chained Equations\u003c/p\u003e\n\u003cp\u003eATP 3: Adult Treatment Panel III\u003c/p\u003e\n\u003cp\u003eUAE: United Arab Emirates\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Research and Ethics committees of Sheikh Khalifa Medical City, Al Ain Medical District, as well as The College of Medicine \u0026amp; Health Sciences, UAE University, Abu Dhabi. Written informed consent was obtained at the time of the preoperative visit.\u0026nbsp;\u003cstrong\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNot applicable.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are restricted and cannot be shared publicly as it is owned by the institution (Sheikh Khalifa Medical City).\u0026nbsp;All Relevant data are included in this published article. If any additional data/files are required may be obtained from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the concept, design of the study, read and approved the final manuscript. FMA, AAM, ASA, RZA, and DMA Participated in the acquisition of data, statistical analysis, interpretation of data, editing, drafting of the manuscript, and revising it critically for important intellectual content. AAA, FA, and AN participated in the interpretation of data, editing, drafting of the manuscript and revising it critically for important intellectual content.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSKMC administration for facilitating data collection\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[ Dr Fawaz Torab] \u0026nbsp;passed away before the submission of the final version of this manuscript. [Amal Abdul Rahim Al Zarooni] accepts responsibility for the integrity and validity of the data collected and analyzed.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCardiovascular diseases (CVDs). Accessed November 1, 2021. https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)\u003c/li\u003e\n \u003cli\u003esearch results - World Health Organization . (2014, july). Noncommunicable Diseases (NCD) Country Profiles. Retrieved from World Health Organization : http://apps.who.int/iris/bitstream/10665/128038/1/9789241507509_eng.pdf. Accessed November 1, 2021. https://www.bing.com/search?q=World+Health+Organization+.+%282014%2C+july%29.+Noncommunicable+\u003cbr\u003eDiseases+%28NCD%29+Country+Profiles.+Retrieved+from+World+Health+Organization+%3A+\u003cbr\u003ehttp%3A%2F%2Fapps.who.int%2Firis%2Fbitstream%2F10665%2F128038%2F1%2F9789241507509_\u003cbr\u003eeng.pdf\u0026amp;go=Search\u0026amp;qs=ds\u0026amp;form=QBRE\u003c/li\u003e\n \u003cli\u003eRicci C, Gaeta M, Rausa E, Asti E, Bandera F, Bonavina L. Long-Term Effects of Bariatric Surgery on Type II Diabetes, Hypertension and Hyperlipidemia: A Meta-Analysis and Meta-Regression Study with 5-Year Follow-Up. \u003cem\u003eObes Surg\u003c/em\u003e. 2015;25(3):397-405. doi:10.1007/s11695-014-1442-4\u003c/li\u003e\n \u003cli\u003eObesity and overweight. Accessed November 1, 2021. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\u003c/li\u003e\n \u003cli\u003eLargent JA, Vasey J, Bessonova L, Okerson T, Wong ND. Reduction in Framingham Risk of Cardiovascular Disease in Obese Patients Undergoing Laparoscopic Adjustable Gastric Banding. \u003cem\u003eAdv Ther\u003c/em\u003e. 2013;30(7):684-696. doi:10.1007/s12325-013-0045-0\u003c/li\u003e\n \u003cli\u003eCDC. CDC Works 24/7. Centers for Disease Control and Prevention. Published October 28, 2021. Accessed November 1, 2021. https://www.cdc.gov/index.htm\u003c/li\u003e\n \u003cli\u003eStandards of Medical Care in Diabetes\u0026mdash;2016 Abridged for Primary Care Providers. \u003cem\u003eClin Diabetes\u003c/em\u003e. 2016;34(1):3-21. doi:10.2337/diaclin.34.1.3\u003c/li\u003e\n \u003cli\u003eJames PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). \u003cem\u003eJAMA\u003c/em\u003e. 2014;311(5):507. doi:10.1001/jama.2013.284427\u003c/li\u003e\n \u003cli\u003eCleeman J. ATP III Guidelines At-A-Glance Quick Desk Reference. :6.\u003c/li\u003e\n \u003cli\u003eR: The R Project for Statistical Computing. Accessed November 1, 2021. https://www.r-project.org/\u003c/li\u003e\n \u003cli\u003eBuuren S van, Groothuis-Oudshoorn K. \u003cstrong\u003emice\u003c/strong\u003e : Multivariate Imputation by Chained Equations in \u003cem\u003eR\u003c/em\u003e. \u003cem\u003eJ Stat Softw\u003c/em\u003e. 2011;45(3). doi:10.18637/jss.v045.i03\u003c/li\u003e\n \u003cli\u003eFramingham Risk Score (ATP-III). Accessed November 1, 2021. https://reference.medscape.com/calculator/253/framingham-risk-score-atp-iii\u003c/li\u003e\n \u003cli\u003eVest AR, Heneghan HM, Agarwal S, Schauer PR, Young JB. Bariatric surgery and cardiovascular outcomes: a systematic review. \u003cem\u003eHeart\u003c/em\u003e. 2012;98(24):1763-1777. doi:10.1136/heartjnl-2012-301778\u003c/li\u003e\n \u003cli\u003eBatsis JA, Miranda WR, Prasad C, et al. Effect of bariatric surgery on cardiometabolic risk in elderly patients: A population-based study: Bariatric surgery and older adults. \u003cem\u003eGeriatr Gerontol Int\u003c/em\u003e. 2016;16(5):618-624. doi:10.1111/ggi.12527\u003c/li\u003e\n \u003cli\u003eBatsis JA, Sarr MG, Collazo-Clavell ML, et al. Cardiovascular Risk After Bariatric Surgery for Obesity. \u003cem\u003eAm J Cardiol\u003c/em\u003e. 2008;102(7):930-937. doi:10.1016/j.amjcard.2008.05.040\u003c/li\u003e\n \u003cli\u003eHeneghan HM, Meron-Eldar S, Brethauer SA, Schauer PR, Young JB. Effect of Bariatric Surgery on Cardiovascular Risk Profile\u0026dagger;Drs. Heneghan and Meron-Eldar contributed equally to this article. \u003cem\u003eAm J Cardiol\u003c/em\u003e. 2011;108(10):1499-1507. doi:10.1016/j.amjcard.2011.06.076\u003c/li\u003e\n \u003cli\u003eOwen JG, Yazdi F, Reisin E. Bariatric Surgery and Hypertension. \u003cem\u003eAm J Hypertens\u003c/em\u003e. 2018;31(1):11-17. doi:10.1093/ajh/hpx112\u003c/li\u003e\n \u003cli\u003eBuchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery: A Systematic Review and Meta-analysis. \u003cem\u003eJAMA\u003c/em\u003e. 2004;292(14):1724. doi:10.1001/jama.292.14.1724\u003c/li\u003e\n \u003cli\u003eSchroeder R, Harrison TD. Treatment of Adult Obesity with Bariatric Surgery. \u003cem\u003eBariatr Surg\u003c/em\u003e. 2016;93(1):7.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 2 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cardiovascular risk score, bariatric surgery, Framingham risk score, Type 2 Diabetes, dyslipidemia, and hypertension.","lastPublishedDoi":"10.21203/rs.3.rs-5983645/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5983645/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBACKGROUND\u003c/b\u003e\u003c/p\u003e \u003cp\u003eObesity is a global health issue with significant public health implications. In addition, obesity plays a role in the development of obesity-related chronic illnesses like type 2 diabetes [T2DM], dyslipidemia, hypertension [HTN], and major adverse cardiovascular events [MACE]. Metabolic and bariatric surgery leads to significant and sustained weight loss and improves T2DM, HTN, dyslipidemia, and a lower rate of MACEs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOBJECTIVE\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo assess the impact of Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG] on Framingham risk score and the major modifiable cardiovascular risk factors including Type 2 Diabetes, dyslipidemia, and hypertension.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMATERIALS AND METHODS\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA single-center retrospective cohort study, for all adult patients with obesity who underwent RYGB or SG at the Bariatric \u0026amp; Metabolic Institute (BMI Abu Dhabi) at Sheikh Khalifa Medical City (SKMC), United Arab Emirates (UAE) from January 2010 to December 2013. The cardiovascular risk score was calculated for 2 years before and 2 years after undergoing RYGB or SG for each patient. Electronic medical records were reviewed. All statistical analysis and data analysis were carried out using the R software, version 3.0.3\u003c/p\u003e\u003cp\u003e\u003cb\u003eRESULTS\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDuring the study period, 363 adults with obesity underwent bariatric surgery at BMI Abu Dhabi (220 patients had Laparoscopic Roux-en Y gastric bypass (RYGB), 102 patients had Laparoscopic sleeve gastrectomy (SG), and 41 patients had other type of bariatric procedures). The overall risk reduction in cardiovascular risk score was 34.02% over 2 years from baseline. There was a significant reduction in the cardiovascular risk score in the first year after RYGB and SG followed by a plateau for the second year. Additionally, systolic blood pressure (SBP) improved by 9.02%, diastolic blood pressure (DBP) improved by 7.52%, and body mass index (BMI) improved by 39.93%. In addition, the total cholesterol, triglycerides, and low-density lipoprotein (LDL) levels declined by 9.07%, 29.98%, and 21.93% respectively. Furthermore, there was a considerable increase in high-density lipoprotein (HDL) levels of 35.65% over the same time, drop in glycated Hemoglobin (HbA1c) by 10.79%, drop in fasting blood glucose (FBS) by 10.30%, and drop in random blood glucose (RBG) by 15.55%.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCONCLUSION\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA significant reduction in cardiovascular risk score after RYGB and SG was observed. In addition, RYGB and SG led to significant weight loss and improvement in other obesity-related medical conditions.\u003c/p\u003e","manuscriptTitle":"The Effect of Roux-en-Y gastric bypass and sleeve gastrectomy on adults with obesity and its Impact on Their Cardiovascular Risk Assessment Score in Abu Dhabi, United Arab Emirates","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-21 15:48:04","doi":"10.21203/rs.3.rs-5983645/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9bc46b2e-c325-48fd-b286-666d16d22263","owner":[],"postedDate":"February 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-21T15:48:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-21 15:48:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5983645","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5983645","identity":"rs-5983645","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}