IMPACT OF BARIATRIC SURGERY ON CARDIOVASCULAR RISK FACTORS: A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.1(49).2026.5162Keywords:
Bariatric Surgery, Obesity, Cardiovascular Disease, Metabolic SurgeryAbstract
Obesity can be considered a global pandemic, already affecting a considerable and increasing number of adults. It has been described as one of the most important preventable causes of cardiovascular morbidity and mortality. Obesity accelerates the development and progression of cardiovascular disease through its strong correlations with hypertension, dyslipidemia, insulin resistance, type 2 diabetes mellitus, systemic inflammation, and adverse cardiac remodeling. Bariatric surgery, the current most effective long-term treatment for obesity, has increasingly been recognized as a metabolic intervention with benefits to the cardiovascular system. Accumulating evidence indicates that surgical weight loss is accompanied by rapid and sustained improvements in glycemic control, with high rates of diabetes remission, significant reductions in blood pressure, and favorable changes in lipid profiles. In parallel, bariatric procedures lead to attenuation of chronic low-grade inflammation, improvement in endothelial function, and regression of obesity-related cardiac structural abnormalities. Studies demonstrate a substantial reduction in major adverse cardiovascular events and cardiovascular mortality among surgically treated patients compared with matched nonsurgical controls. These benefits may result from both weight-dependent and weight-independent mechanisms, including alterations in gut hormones, bile acid metabolism, insulin sensitivity, and neurohormonal regulation. This narrative review aims to present the current evidence on the effects of bariatric surgery on established cardiovascular risk factors, discuss potential mechanistic pathways, types of bariatric procedures and emphasize the role of metabolic surgery as an effective strategy for reducing cardiovascular risk in individuals with obesity.
References
Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., Kattan, M. W., & Nissen, S. E. (2019). Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA, 322(13), 1271–1282. https://doi.org/10.1001/jama.2019.14231
Aminian, A., Wilson, R., Zajichek, A., Tu, C., Wolski, K. E., Schauer, P. R., Kattan, M. W., Nissen, S. E., & Brethauer, S. A. (2021). Cardiovascular outcomes in patients with type 2 diabetes and obesity: Comparison of gastric bypass, sleeve gastrectomy, and usual care. Diabetes Care, 44(11), 2552–2563. https://doi.org/10.2337/dc20-3023
Angrisani, L., Santonicola, A., Iovino, P., Vitiello, A., Zundel, N., Buchwald, H., & Scopinaro, N. (2017). Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obesity Surgery, 27, 2279–2289. https://doi.org/10.1007/s11695-017-2666-x
Apovian, C. M., Aronne, L. J., Bessesen, D. H., McDonnell, M. E., Murad, M. H., Pagotto, U., Ryan, D. H., & Still, C. D. (2015). Pharmacological management of obesity: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(2), 342–362. https://doi.org/10.1210/jc.2014-3415
Benaiges, D., Más-Lorenzo, A., Goday, A., Ramon, J. M., Chillarón, J. J., Pedro-Botet, J., & Flores-Le Roux, J. A. (2015). Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure? World Journal of Gastroenterology, 21(41), 11804–11814. https://doi.org/10.3748/wjg.v21.i41.11804
Blüher, M. (2019). Obesity: Global epidemiology and pathogenesis. Nature Reviews Endocrinology, 15, 288–298. https://doi.org/10.1038/s41574-019-0176-8
Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292(14), 1724–1737. https://doi.org/10.1001/jama.292.14.1724
Cuspidi, C., Rescaldani, M., Tadic, M., Sala, C., & Grassi, G. (2014). Effects of bariatric surgery on cardiac structure and function: A systematic review and meta-analysis. American Journal of Hypertension, 27(2), 146–156. https://doi.org/10.1093/ajh/hpt215
Després, J. P. (2012). Body fat distribution and risk of cardiovascular disease: An update. Circulation, 126(10), 1301–1313. https://doi.org/10.1161/CIRCULATIONAHA.111.067264
GBD 2019 Risk Factors Collaborators. (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1223–1249. https://doi.org/10.1016/S0140-6736(20)30752-2
Kang, J. H., & Le, Q. A. (2017). Effectiveness of bariatric surgical procedures: A systematic review and network meta-analysis of randomized controlled trials. Medicine, 96(46), e8632. https://doi.org/10.1097/MD.0000000000008632
Latteri, S., Sofia, M., Puleo, S., Di Vincenzo, A., Cinti, S., & Castorina, S. (2023). Mechanisms linking bariatric surgery to adipose tissue, glucose metabolism, fatty liver disease, and gut microbiota. Langenbeck’s Archives of Surgery, 408, 101. https://doi.org/10.1007/s00423-023-02821-8
Lavie, C. J., De Schutter, A., & Milani, R. V. (2015). Healthy obese versus unhealthy lean: The obesity paradox. Nature Reviews Endocrinology, 11, 55–62. https://doi.org/10.1038/nrendo.2014.165
Lavie, C. J., Pandey, A., Lau, D. H., Alpert, M. A., & Sanders, P. (2017). Obesity and atrial fibrillation prevalence, pathogenesis, and prognosis: Effects of weight loss and exercise. Journal of the American College of Cardiology, 70(16), 2022–2035. https://doi.org/10.1016/j.jacc.2017.09.002
Li, X., Wang, S., Sun, L., Sun, Z., Xu, Y., Ren, J., Yu, H., Han, X., & Bai, W. (2025). Effects of bariatric surgery on endothelial function and structure in individuals with obesity: A prospective study. Obesity Surgery, 35, 3082–3092. https://doi.org/10.1007/s11695-025-08004-2
Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Capristo, E., Chamseddine, G., Borstein, S. R., & Rubino, F. (2021). Metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial. The Lancet, 397(10271), 293–304. https://doi.org/10.1016/S0140-6736(20)32649-0
Piché, M. E., Tardif, I., Auclair, A., & Poirier, P. (2021). Effects of bariatric surgery on lipid-lipoprotein profile. Metabolism, 115, 154441. https://doi.org/10.1016/j.metabol.2020.154441
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J. P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., & St-Onge, M. P. (2021). Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 143(21), e984–e1010. https://doi.org/10.1161/CIR.0000000000000973
Rubino, F., Nathan, D. M., Eckel, R. H., Schauer, P. R., Alberti, K. G. M. M., Zimmet, P. Z., Del Prato, S., Ji, L., Sadikot, S. M., Herman, W. H., Amiel, S. A., Kaplan, L. M., Taroncher-Oldenburg, G., & Cummings, D. E. (2016). Metabolic surgery in the treatment algorithm for type 2 diabetes: A joint statement by international diabetes organizations. Diabetes Care, 39(6), 861–877. https://doi.org/10.2337/dc16-0236
Schauer, P. R., Bhatt, D. L., Kirwan, J. P., Wolski, K., Aminian, A., Brethauer, S. A., Navaneethan, S. D., Singh, R. P., Pothier, C. E., Nissen, S. E., & Kashyap, S. R. (2017). Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. New England Journal of Medicine, 376(7), 641–651. https://doi.org/10.1056/NEJMoa1600869
Schiavon, C. A., Bersch-Ferreira, A. C., Santucci, E. V., Oliveira, J. D., Torreglosa, C. R., Bueno, P. T., Frayha, J. C., Santos, R. N., Damiani, L. P., Noujaim, P. M., Halpern, H., Monteiro, F. L. J., Cohen, R. V., Uchoa, C. H., de Souza, M. G., Amodeo, C., Bortolotto, L., Ikeoka, D., Drager, L. F., ... Berwanger, O. (2018). Effects of bariatric surgery in obese patients with hypertension: The GATEWAY randomized trial (Gastric bypass to treat obese patients with steady hypertension). Circulation, 137(11), 1132–1142. https://doi.org/10.1161/CIRCULATIONAHA.117.032130
Shimada, Y. J., Goto, T., Tsugawa, Y., Yu, E. W., Yoshida, K., Homma, S., Brown, D. F. M., & Hasegawa, K. (2019). Comparative effectiveness of gastric bypass versus gastric banding on acute care use for cardiovascular disease in adults with obesity. Nutrition, Metabolism, and Cardiovascular Diseases, 29(5), 518–526. https://doi.org/10.1016/j.numecd.2019.02.001
Sjöström, L. (2013). Review of the key results from the Swedish Obese Subjects (SOS) trial. Journal of Internal Medicine, 273(3), 219–234. https://doi.org/10.1111/joim.12012
Vest, A. R., Heneghan, H. M., Agarwal, S., Schauer, P. R., & Young, J. B. (2012). Bariatric surgery and cardiovascular outcomes: A systematic review. Heart, 98(24), 1763–1777. https://doi.org/10.1136/heartjnl-2012-301778
World Health Organization. (2025, December 8). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Lee, Y. H., & Pratley, R. E. (2005). The evolving role of inflammation in obesity and the metabolic syndrome. Current Diabetes Reports, 5, 70–75. https://doi.org/10.1007/S11892-005-0071-7
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Bruno Makowski, Oliwia Marciniak, Dawid Szczepański, Grzegorz Jałoszyński, Marcin Patryk Barbachowski, Maciej Makarewicz, Anna Gwizdek, Natalia Bylak, Norbert Gromadzki, Sebastian Konecki, Maria Kurt
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
How to Cite
