ClinicalGeneralImproved heart rate recovery after marked weight loss induced by gastric bypass surgery: Two-year follow up in the Utah Obesity Study
Introduction
Overweight and obesity are associated with increased overall mortality, particularly from cardiovascular disease.1, 2, 3, 4 Gastric bypass surgery (GBS) is becoming an increasingly popular weight loss method for many severely obese people.5 In addition to weight loss on the order of 40%,6 GBS patients generally see improvements in lipid profile,7 glucose tolerance,8 blood pressure (BP),9 endothelial function,10 and sleep apnea.11 A few studies have reported improvements in left ventricular function after GBS, although this is less well substantiated.12 The duration of the beneficial effects of GBS have not been fully established.13, 14 Although bariatric surgery is associated with potentially detrimental short- and long-term effects, the benefits appear to outweigh the risks. Recent data indicate significant reductions in total and cause-specific mortality in patients undergoing GBS.15 The mechanism(s) accounting for the decreased mortality is not fully known. Also unknown is whether there exist surrogate markers of survival that might help to more quickly evaluate outcomes associated with the expanding use of weight loss surgery.
The decrease in heart rate (HR) during the first 1 to 2 minutes after exercise termination, referred to as HR recovery, is an indirect measure of the balance between cardiac parasympathetic (vagal) and sympathetic tone.16, 17 Faster recovery of HR toward baseline is a marker of higher cardiovascular fitness levels, and in large studies more rapid HR recovery has been associated with better long-term survival.18 Conversely, reduced HR recovery is a strong indicator of high cardiovascular risk and higher mortality.18, 19 It has recently been reported that a short-term (12 week), diet-based weight loss program in overweight men resulted in a significant increase in HR recovery after maximal exercise.20 However, whether similar benefits can be attributed to weight loss induced by GBS and the duration of such benefits are unknown.
In the current study, we measured HR recovery after exercise at baseline and 2 years after GBS or nonsurgical treatment. We hypothesized that marked weight loss after GBS would be associated with improvement in HR recovery.
Section snippets
Study population
The study protocol was approved by the institutional review board of the University of Utah Health Sciences Center. All patients signed a written consent form. The rationale and design of the Utah Obesity Study has previously been reported.21 From among the 1,156 initial patients, we studied 341 patients (GBS group, n = 153; nonsurgical group, n = 188) who had complete treadmill data at both baseline and 2-year follow up. Roux-en-Y GBS was performed in all surgical patients. The procedure was
Patient characteristics
The population was 85% female in the GBS group and 81% female in the nonsurgical group. Age at the beginning of the study was 43 ± 11 years in the GBS group and 48 ± 11 years in the nonsurgical group. Subjects in the GBS group lost an average of 100 ± 37 lb (range 0–263 lb). The nonsurgical group lost an average of 3 ± 22 lb (range +52 to –130 lb). Anthropomorphic and blood chemistry variables all improved with significant weight loss in the GBS group (Table 1).
Discussion
Our data show that significant weight loss 2 years after GBS is associated with (1) markedly improved exercise capacity, (2) a reduction in resting HR and systolic BP, and (3) a marked improvement in HR recovery after exercise. These changes are likely contributed to by a relative enhancement of cardiac vagal tone, with potential contributions from decreased resting sympathetic tone and more rapid sympathetic withdrawal after termination of exercise. The improvements in the physiologic
References (41)
Results of surgery: long-term effects on hyperlipidemia
Am J Clin Nutr
(1992)- et al.
Effect of medical and surgical weight loss on endothelial vasomotor function in obese patients
Am J Cardiol
(2005) - et al.
Effects of weight loss after gastric bypass on right and left ventricular function assessed by tissue Doppler imaging
Am J Cardiol
(2005) - et al.
Assessing autonomic function by analysis of heart rate recovery from exercise in healthy subjects
Am J Cardiol
(2004) - et al.
Weight loss improves heart rate recovery in overweight and obese men with features of the metabolic syndrome
Am Heart J
(2006) - et al.
Design and rationale of the Utah obesity studyA study to assess morbidity following gastric bypass surgery
Contemp Clin Trials
(2005) - et al.
Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery
Am J Cardiol
(2007) - et al.
Sudden cardiac arrest in morbidly obese surgical patients unexplained after autopsy
Am J Surg
(1988) - et al.
Metabolic syndrome: yet another co-morbidity gastric bypass helps cure
Surg Obes Relat Dis
(2006) - et al.
Mechanisms linking obesity with cardiovascular disease
Nature
(2006)
Medical hazards of obesity
Ann Intern Med
Cardiovascular mortality in overweight subjects: the key role of associated risk factors
Hypertension
Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study
Circulation
Laparoscopic surgery for morbid obesity: 1,001 consecutive bariatric operations performed at The Bariatric Institute, Cleveland Clinic Florida
Obes Surg
Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
N Engl J Med
Loss of insulin resistance after Roux-en-Y gastric bypass surgery: a time course study
Obes Surg
Long-term changes in blood pressure in extremely obese patients who have undergone bariatric surgery
Arch Surg
Continuous positive airway pressure (CPAP) changes in bariatric surgery patients undergoing rapid weight loss
Obes Surg
Follow-up of nutritional and metabolic problems after bariatric surgery
Diabetes Care
Nutritional deficiencies following bariatric surgery: what have we learned?
Obes Surg
Cited by (36)
Correlation between body fat and post-exercise heart rate in healthy men and women
2017, Science and SportsCitation Excerpt :Brinkworth et al. [15] reported improved post-exercise HR in 42 overweight and obese middle age men (46.5 ± 1.3 years) after 12 weeks of weight loss program. Similar results of improved autonomic function (and HR responses) were found in obese men with metabolic syndrome [16] or severely obese patients with gastric bypass surgery [17] after weight reduction intervention. However, above studies typically applied simple correlation models linking body composition and post-exercise HR that rarely control for confounding factors.
Cardiovascular benefits of bariatric surgery
2016, Trends in Cardiovascular MedicineCitation Excerpt :There is also emerging evidence to suggest that bariatric surgery reverses intrathoracic lipotoxicity by decreasing the epicardial fat volume [78]. Blunted heart rate recovery after exercise is common in obese subjects and is a powerful predictor of increased mortality; data from the Utah Obesity Study suggests that bariatric surgery, and the ensuing weight loss, results in an enhancement of heart rate recovery after exercise [79]. Finally, the sustained weight loss following bariatric surgery improves quality of life and overall physical activity; it has been shown that positive psychological well-being and increased physical activity have beneficial effects on cardiovascular health [80,81].
Relation between heart rate recovery after exercise testing and body mass index
2015, Revista Portuguesa de CardiologiaEffects of Exercise Mode on Improving Cardiovascular Function and Cardiorespiratory Fitness After Bariatric Surgery: A Narrative Review
2022, American Journal of Physical Medicine and RehabilitationOrthostatic intolerance after bariatric surgery: A systematic review and meta-analysis
2021, Clinical Obesity
This investigation was supported by National Institutes of Health (NIDDK) Grant DK-55006, National Institutes of Health Grant R01 HL084294-01 A1, and Public Health Service Research Grant No. M01-RR00064 from the National Center for Research Resources.