Improvement of metabolic and cardiovascular outcomes after bariatric surgery: from bench to bedside

Obesity is a complex multifactorial metabolic disorder linked to a myriad of endocrine, cardiovascular, and musculoskeletal, oncologic and neuropsychiatric complications. A large epidemiologic boom has been observed in the epidemiologic trends of obesity in recent decades, paralleling those of cardiovascular disease (CVD). Indeed, the combination of obesity and CVD represents an essential problem for everyday clinical practice; which has prompted a surge in the development of treatment alternatives for obesity. Bariatric surgery (BS) remains a valuable tool in this armamentarium, in particular for complex cases with several comorbidities. BS has been observed to grant particularly valuable advantages, producing profound and durable improvements in metabolic and cardiovascular health, mediated by a multifaceted interplay of mechanisms extending beyond weight loss alone. Anatomical alterations to the gastrointestinal tract trigger rapid changes in enteroendocrine signaling and local and systemic inflammation, which together enhance insulin sensitivity, optimize lipid handling, reduce and restore autonomic balance, and promote beneficial hemodynamic changes. These pathophysiological adaptations translate into clinically meaningful outcomes, including high rates of type 2 diabetes remission, sustained improvements in dyslipidemia and hypertension, reduced incidence of major adverse cardiovascular events, and decreased all-cause and cardiovascular mortality. In this article, we revise the mechanisms and epidemiology of the amelioration of metabolic and cardiovascular outcomes after BS.