Patients undergoing laparoscopic adjustable gastric band (LAGB) have significant weight loss and reductions in estimated ten to 30-year cardiovascular risk within one year post-LAGB, according to a study published in the journal Advances in Therapy, a Springer link publication.

 Data from a US healthcare database revealed that ten- and 30-year estimated cardiovascular risk decreased from 10.8 to 7.6% (p\0.0001) and 44.34 to 32.30% (p\0.0001), respectively, 12–15 months post-LAGB. Improvements were significantly greater than in non-LAGB patients (n= 4,295) (p\0.0001).

The researchers set out to examine whether weight loss in obese patients treated with LAGB is associated with meaningful reductions in estimated 10- and 30- year Framingham CVD risk 12–15 months post-LAGB.

Obese adult patients (BMI30) treated with LAGB were identified in a large US healthcare database. Patients without CVD at baseline and with measures of BMI, systolic blood pressure, diabetes, and smoking status at baseline and follow-up were eligible. Non- LAGB patients were propensity score matched to LAGB patients on baseline BMI, age, and gender.

The estimated 10- and 30-year Framingham CVD risks were 10.8 and 44.34% for LAGB patients and 10.56 and 41.79% for comparison patients at baseline, respectively.

Results

The outcomes showed that the mean BMI in LAGB patients (n= 647, average age 45.66 years, 81.1% female) decreased from 42.7 to 33.4 (p\0.0001), with 35.4% no longer obese.

In the subset with lipid data (n=74), improvements in total (-20.6mg/dL; p\0.05) and high-density lipoprotein ( 10.6 mg/dL, p\0.0001) cholesterol 1 year post-LAGB were also observed.

At 12–15 months’ follow-up, mean BMI decreased significantly in LAGB patients (-9.3kg/m2, p\0.0001) and in comparison patients (-0.6kg/m2, p\0.0001. In addition, the researchers also report that there were significant reductions in SBP for both LAGB (p\0.0001) and comparison patients (p\0.05). At follow-up, the proportion of patients using anti-diabetic medications decreased in LAGB patients (p\0.0001) and increased in comparison group (p\0.01).

Estimated 10- and 30-year CVD risk scores decreased significantly in LAGB patients (-3.2%, p\0.0001 and -12.04%, p\0.0001, respectively), but did not change significantly in comparison patients ( 0.01%, p= 0.91 and  0.13%, p= 0.42, respectively). Changes in CVD risk factors and scores were evaluated for subgroups stratified by gender and

baseline BMI (Figure 1).

Figure 1: Change in estimated 10- and 30-year CVD risk at 12–15 months by gender and baseline BMI. BMI body mass index, CVD cardiovascular disease, LAGB laparoscopic adjustable gastric banding. *P\0.05 for changes from baseline between LAGB and non-LAGB groups; BMI was presented as kg/m2.

Although the authors acknowledge that Framingham CVD risk scores have not been validated for measuring changes in CVD risk over time or specifically in obese populations, “in the present analysis scores based on BMI versus lipid data indicate similar and consistent magnitude of risk reduction,” they note.

Conclusion

The researchers concluded that the data showed patients receiving LAGB to have significant weight loss, and reduced CVD risk factors and estimated CVD risk, supporting the effectiveness of the LAGB procedure as a potential approach for management of obesity.

“These results add to the evidence of the cardiovascular benefits of significant weight loss among obese individuals and the potential long-term clinical impact of the LAGB procedure as a therapeutic intervention for obesity,” the researchers write. “Larger and long-term studies are needed to further document whether effects of LAGB on weight loss and CVD risk factors translate into reduced CVD incidence.”

The analysis and publication charges were sponsored by Allergan.

Owen Haskins – Editor in chief, Bariatric News

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