Cardiovascular Disease

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Obesity is associated with an increased risk of coronary artery disease (CAD) and mortality from cardiac events including myocardial infarction, arrhythmias, and sudden cardiac death (46). Morbidity and mortality rates rise proportionally to the degree of obesity in men and women, and the impact of excess body fat is more significant in younger subjects than in older ones (47). Heart function is directly influenced by excess body fat (52). In addition to higher cardiac output in obese patients, left ventricular volume and filling pressures are higher than normal. This frequently results in the development of left ventricular strain, which leads to hypertrophy, often of the eccentric type (53). Left ventricular diastolic function is frequently impaired by this effect. Weight loss has a beneficial impact on the functional and the structural cardiac status. In a study of obese patients with a mean BMI of 32.7, weight loss of 8 kg over a period of 25 wk was associated with a significant decrease in left ventricular mass (54). Weight loss also lowers blood pressure. In a 3-yr follow-up of nonmorbidly obese patients with a mean BMI of 31, patients who maintained a 4.5-kg weight loss had a relative risk of hypertension of 0.35, or a reduction of 0.45 mmHg in systolic blood pressure and 0.35 mmHg in diastolic pressure per kilogram of weight lost (51). Finally, as compared with conventional therapies for weight loss (diet, drugs, lifestyle modification), bariatric surgery appears to be the best option for the treatment of the morbidly obese, resulting in long-term weight loss, improved lifestyle, and amelioration in cardiovascular risk factors that were elevated at baseline.

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