Gender Disparity in Cardiac Outcomes Found After Bariatric Surgery

By Megan Brooks

November 09, 2016

NEW YORK (Reuters Health) - After bariatric surgery, women have a lower risk of heart disease than men, a new study finds.

While both genders significantly reduce their risk of developing cardiovascular disease over the next decade, women seem to benefit more, the study suggests.

"This study shows there is a gender disparity in cardiac outcomes for patients undergoing bariatric surgery," lead investigator Dr. John M. Morton of Stanford Hospital & Clinics in California said in a statement.

"The findings suggest that women may have an enhanced mechanism of response to bariatric surgery, which leads to greater normalization of biochemical cardiac risk factors," he added.

Dr. Morton presented the study November 4 in New Orleans during ObesityWeek 2016 hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

He and his colleagues followed close to 2,000 patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy at the Stanford BMI Clinic. They collected cardiac risk factor data before and one year after surgery and used the Framingham Coronary Heart Disease Risk Score to estimate the risk of myocardial infarction in the 10 years before surgery and at one year after surgery.

One year after surgery, women reduced their risk of heart disease by 41%, while men reduced their risk by about 36%, the researchers report.

After surgery, men were able to normalize levels of HbA1c and triglycerides and waist circumference better than women, suggesting that men may be more metabolically receptive to bariatric surgery, they note.

Women, on the other hand, were able to normalize levels of C-reactive protein better, maintain higher HDL levels, and had a higher percent of excess weight loss following surgery compared to men (73% vs. 66%).

Both genders showed significant cardiac risk improvement after bariatric surgery, albeit through gender-distinct mechanisms it seems, the researchers note.

"This study shows that men and women react differently to bariatric surgery," Dr. Morton told Reuters Health by phone. "Both genders improved in terms of their cardiac risk factors but women improved more and the risk factors that were improved were different."

The fact that HDL levels improved more in men than women, while the C-reactive protein improved more in women, suggests that there may be "different pathways for that lipid metabolism and inflammatory cascade for each gender and it points out that we are learning that we have to tailor our treatment differently," Dr. Morton said.

"I think heart disease is something that is still under-treated, under-recognized in our female population, which is important because 80% of (bariatric) patients are women," he added. "The end result is that men and women both get better but they get better in different ways."


ObesityWeek 2016.