IMPACT OF BARIATRIC SURGERY ON CARDIOVASCULAR RISK REDUCTION: IS THERE STILL ROOM FOR THIS TREATMENT?

Abstract

Introduction: Obesity is excess body fat, characterized by a BMI ≥30 kg/m², is recognized as a chronic, multifactorial disease, and requires multidisciplinary approaches, associated with health hazards, such as cardiovascular risk, systemic arterial hypertension, type 2 diabetes mellitus, in addition to predisposition to the development of cancer. The increase in cases in the twenty-first century highlights the difficulty in dealing with this issue. Objective: To identify an association between bariatric surgery and decreased cardiovascular risk in obese patients and to compare drug treatment. Methodology: Articles from 2015-2024 were used in the Google Scholar, Scielo, and Pubmed databases, with the descriptors: "Obesity", "Bariatric surgery", "Cardiovascular risk", "Drug treatment", "Semaglutide", and "Hypertension", and included Gateway studies and the 2019 PRISMA tool. Results: In the study by Rabello et al (2016), a ≥30% reduction in the use of antihypertensive drugs was observed, keeping blood pressure controlled in the group of patients undergoing bariatric surgery. In addition, there was an improvement in glycemic and triglyceride levels, with a mean reduction after 3 months, comparing patients undergoing pharmacological treatment, who did not show clinical variation only in glucagon values (18.1±20.7 vs. 16.8±18.4 pg/ml, p<0.001), thus defining surgical treatment as the best option for reducing cardiovascular risk in obese patients. The GATEWAY study, by Shiavon (2018), compared the effects of metabolic surgery in obese and hypertensive patients. The 100 selected women, aged 34 and 53 years, 76% women, were randomly submitted to Roux-en-Y gastric bypass. The result was a reduction of ≥30% total of antihypertensive drugs while maintaining controlled blood pressure. Conclusion: Bariatric surgery favors the reduction of visceral fat, control of comorbidities, and prevention of the risk of cardiometabolic diseases. The results indicate that metabolic surgery is effective in reducing mortality and complication rates, both macro and microvascular, such as systemic arterial hypertension and dyslipidemia, minimizing adverse cardiovascular outcomes. Although there has been progress in the results of clinical drug treatments, such as tirzepatide, bariatric remains an important and viable therapeutic option to treat obesity and reduce unfavorable cardiovascular clinical outcomes.