Author + information
- Received September 15, 2017
- Revision received December 13, 2017
- Accepted December 15, 2017
- Published online February 5, 2018.
- Manan Pareek, MD, PhDa,b,
- Philip R. Schauer, MDc,
- Lee M. Kaplan, MD, PhDd,
- Lawrence A. Leiter, MDe,
- Francesco Rubino, MDf and
- Deepak L. Bhatt, MD, MPHa,∗ ()
- aBrigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
- bCardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Odense University Hospital, Odense, Denmark
- cBariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
- dObesity, Metabolism and Nutrition Institute, Massachusetts General Hospital, Boston, Massachusetts
- eLi Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- fDepartment of Metabolic and Bariatric Surgery, Diabetes and Nutritional Science Division, King’s College Hospital, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Deepak L. Bhatt, Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115.
The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further examines their potential effects on cardiovascular outcomes and mortality and discusses future perspectives.
Dr. Pareek has served on the advisory board of and received speaker’s honoraria from AstraZeneca. Dr. Schauer has served on the advisory boards of The Medicines Company, GI Dynamics, Neurotronic, and Pacira; has been a consultant for Ethicon, The Medicines Company, and Novo Nordisk; and has received research support from Ethicon, the National Institutes of Health, Medtronic, and Pacira. Dr. Leiter has received research funding from, has provided continuing medical education on behalf of, and/or has acted as an adviser to Amgen, AstraZeneca, Boehringer Ingelheim, Eisai, Eli Lilly, Esperion, GlaxoSmithKline, Janssen, Merck, Novo Nordisk, Sanofi/Regeneron, Servier, and The Medicines Company. Dr. Rubino has served on the scientific advisory boards of Fractyl and GI Dynamics; has received consulting fees from Ethicon and Medtronic; has received speaker’s honoraria from Ethicon and Novo Nordisk; and has received grants from the National Institute for Health Research (UK) and Ethicon. Dr. Bhatt has served on the advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; has served on the board of directors of the Boston VA Research Institute and the Society of Cardiovascular Patient Care; has been Chair of the American Heart Association Quality Oversight Committee; has served on the data monitoring committees of Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, and Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (guest editor; associate editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (chief medical editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (secretary/treasurer), and WebMD (continuing medical education steering committees), Clinical Cardiology (deputy editor), NCDR-ACTION Registry Steering Committee (chair), and VA CART Research and Publications Committee (chair); has received research funding from Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has been site co-investigator for Biotronik, Boston Scientific, and St. Jude Medical; has been a trustee of the American College of Cardiology; and has conducted unfunded research for FlowCo, Merck, PLx Pharma, and Takeda. Dr. Kaplan has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received September 15, 2017.
- Revision received December 13, 2017.
- Accepted December 15, 2017.
- 2018 American College of Cardiology Foundation
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