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Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Review Article

Cardiovascular Effects of Metabolic Surgery on Type 2 Diabetes

Author(s): Christos Damaskos*, Alexandros Litos, Dimitrios Dimitroulis, Efstathios A. Antoniou, Dimitrios Mantas, Konstantinos Kontzoglou and Nikolaos Garmpis

Volume 16 , Issue 4 , 2020

Page: [275 - 284] Pages: 10

DOI: 10.2174/1573403X16666200220120226

Price: $65

Abstract

Introduction: Cardiovascular, together with renal disease, claims a significant proportion of morbidity and mortality in association with type 2 diabetes mellitus (T2DM) and obesity. To improve the long-term renal and cardiovascular outcome, there is the incorporation of bariatric surgery (BS), which seems to be a pivotal intervention.

Areas Explored: Cohort studies and randomized controlled trial (RCT) research of BS among patients with T2DM, were conducted by screening, and then information on renal effects and the cardiovascular outcome was gathered. Metabolic surgery (MS) and BS reduce both mortality and the risk of cardiovascular disorder, chronic kidney diseases and albuminuria. MS refers to a surgical approach, the primary intent of which is the control of metabolic alterations/hyperglycemia in contrast to BS which is a mere weight-reduction therapy. Patients suffering from poor glycaemic control and other macro and micro-vascular diseases will benefit from a surgical approach. The approach implicates hypertension glomerular remission, gut microbiota shift, reduced renal inflammation and fewer instances of chronic cardiac remodelling.

Conclusion: MS is beneficial where the main aim is to attain significant and long-lasting weight loss results. The RCTs have depicted the superiority which surgical mechanisms hold over medically- based therapy, for enhancing glycaemic control, and achieving remission of diabetes. This type of surgery improves life quality, reduces incidences of other obesity and diabetes related diseases like microvascular disases, sleep apnea, fatal disorder, and fatty liver disease.

Keywords: Cardiovascular, metabolic surgery, obesity, type 2 diabetes, bariatric, procedures.

Graphical Abstract
[1]
Martin WP, Docherty NG, Le Roux CW. Impact of bariatric surgery on cardiovascular and renal complications of diabetes: A focus on clinical outcomes and putative mechanisms. Expert Rev Endocrinol Metab 2018; 13(5): 251-62.
[http://dx.doi.org/10.1080/17446651.2018.1518130] [PMID: 30231777]
[2]
Courcoulas AP, Goodpaster BH, Eagleton JK, et al. Surgical vs medical treatments for type 2 diabetes mellitus: A randomized clinical trial. JAMA Surg 2014; 149(7): 707-15.
[http://dx.doi.org/10.1001/jamasurg.2014.467] [PMID: 24899268]
[3]
Ding SA, Simonson DC, Wewalka M, et al. Adjustable gastric band surgery or medical management in patients with type 2 diabetes: A randomized clinical trial. J Clin Endocrinol Metab 2015; 100(7): 2546-56.
[http://dx.doi.org/10.1210/jc.2015-1443] [PMID: 25909333]
[4]
Dajani A, AbuHammour A. Treatment of nonalcoholic fatty liver disease: Where do we stand? An overview. Saudi J Gastroenterol 2016; 22(2): 91-105.
[PMID: 26997214]
[5]
Ryder JR, Gross AC, Fox CK, et al. Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe obesity. Int J Obes 2018; 42(1): 102-7.
[http://dx.doi.org/10.1038/ijo.2017.193] [PMID: 28894289]
[6]
McGrice M, Don Paul K. Interventions to improve long-term weight loss in patients following bariatric surgery: Challenges and solutions. Diabetes Metab Syndr Obes 2015; 8: 263-74.
[http://dx.doi.org/10.2147/DMSO.S57054] [PMID: 26150731]
[7]
Kim J, Eisenberg D, Azagury D, Rogers A, Campos GM. American Society for Metabolic and Bariatric Surgery position statement on long-term survival benefit after metabolic and bariatric surgery. Surg Obes Relat Dis 2016; 12(3): 453-9.
[http://dx.doi.org/10.1016/j.soard.2015.11.021] [PMID: 26944548]
[8]
Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery vs. conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386(9997): 964-73.
[http://dx.doi.org/10.1016/S0140-6736(15)00075-6] [PMID: 26369473]
[9]
Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: The CROSSROADS randomised controlled trial. Diabetologia 2016; 59(5): 945-53.
[http://dx.doi.org/10.1007/s00125-016-3903-x] [PMID: 26983924]
[10]
Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012; 366(17): 1567-76.
[http://dx.doi.org/10.1056/NEJMoa1200225] [PMID: 22449319]
[11]
Ikramuddin S, Billington CJ, Lee WJ, et al. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial. Lancet Diabetes Endocrinol 2015; 3(6): 413-22.
[http://dx.doi.org/10.1016/S2213-8587(15)00089-3] [PMID: 25979364]
[12]
Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: A randomized controlled trial. JAMA 2008; 299(3): 316-23.
[http://dx.doi.org/10.1001/jama.299.3.316] [PMID: 18212316]
[13]
Brown T, Avenell A, Edmunds LD, et al. Systematic review of long-term lifestyle interventions to prevent weight gain and morbidity in adults. Obes Rev 2009; 10(6): 627-38.
[http://dx.doi.org/10.1111/j.1467-789X.2009.00641.x] [PMID: 19754634]
[14]
Pappachan JM, Viswanath AK. Metabolic surgery: A paradigm shift in type 2 diabetes management. World J Diabetes 2015; 6(8): 990-8.
[http://dx.doi.org/10.4239/wjd.v6.i8.990] [PMID: 26240695]
[15]
Gracchi V, van den Belt SM, Küpers LK, Corpeleijn E, de Zeeuw D, Heerspink HJ. Prevalence and distribution of (micro)albuminuria in toddlers. Nephrol Dial Transplant 2016; 31(10): 1686-92.
[http://dx.doi.org/10.1093/ndt/gfv407] [PMID: 26705193]
[16]
Dekkers IA, de Mutsert R, de Vries APJ, et al. Determinants of impaired renal and vascular function are associated with elevated levels of procoagulant factors in the general population. J Thromb Haemost 2018; 16(3): 519-28.
[http://dx.doi.org/10.1111/jth.13935] [PMID: 29285859]
[17]
Fenske WK, Dubb S, Bueter M, et al. Effect of bariatric surgery-induced weight loss on renal and systemic inflammation and blood pressure: A 12-month prospective study. Surg Obes Relat Dis 2013; 9(4): 559-68.
[http://dx.doi.org/10.1016/j.soard.2012.03.009] [PMID: 22608055]
[18]
Lyhne JM, Laugesen E, Høyem P, et al. Morning blood pressure surge and target organ damage in newly diagnosed type 2 diabetic patients: A cross sectional study. BMC Endocr Disord 2015; 15: 77.
[http://dx.doi.org/10.1186/s12902-015-0068-4] [PMID: 26630970]
[19]
Nair M, le Roux CW, Docherty NG. Measuring changes in renal function after bariatric surgery: Why estimated glomerular filtration rate is not good enough. Surg Obes Relat Dis 2016; 12(10): 1897-8.
[http://dx.doi.org/10.1016/j.soard.2016.03.027] [PMID: 27998545]
[20]
Sundbom M, Hedberg J, Marsk R, et al. Substantial decrease in comorbidity five years after gastric bypass: A population-based study from the Scandinavian Obesity Surgery Registry. Ann Surg 2017; 265(6): 1166-71.
[http://dx.doi.org/10.1097/SLA.0000000000001920] [PMID: 27429019]
[21]
Zhou X, Li L, Kwong JS, Yu J, Li Y, Sun X. Impact of bariatric surgery on renal functions in patients with type 2 diabetes: Systematic review of randomized trials and observational studies. Surg Obes Relat Dis 2016; 12(10): 1873-82.
[http://dx.doi.org/10.1016/j.soard.2016.05.003] [PMID: 27421689]
[22]
Leung AA, Nerenberg K, Daskalopoulou SS, et al. Hypertension Canada’s 2016 Canadian hypertension education program guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 2016; 32(5): 569-88.
[http://dx.doi.org/10.1016/j.cjca.2016.02.066] [PMID: 27118291]
[23]
James ND, Sydes MR, Clarke NW, et al. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): Survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 2016; 387(10024): 1163-77.
[http://dx.doi.org/10.1016/S0140-6736(15)01037-5] [PMID: 26719232]
[24]
Bhatt DL, Kashyap S, Schauer PR, et al. Cardiovascular biomarkers after metabolic surgery vs. medical therapy for diabetes: Insights from the STAMPEDE trial. Surg Obes Relat Dis 2018; 14(11): S11-6.
[http://dx.doi.org/10.1016/j.soard.2018.09.026]
[25]
Parker CC, James ND, Brawley CD, et al. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): A randomised controlled phase 3 trial. Lancet 2018; 392(10162): 2353-66.
[http://dx.doi.org/10.1016/S0140-6736(18)32486-3] [PMID: 30355464]
[26]
Tanguay JS, Catlow C, Smith C, et al. High risk of neutropenia for hormone-naive prostate cancer patients receiving STAMPEDE-style upfront docetaxel chemotherapy in usual clinical practice. Clin Oncol (R Coll Radiol) 2016; 28(9): 611.
[http://dx.doi.org/10.1016/j.clon.2016.03.006] [PMID: 27131755]
[27]
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery vs. intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med 2017; 376(7): 641-51.
[http://dx.doi.org/10.1056/NEJMoa1600869] [PMID: 28199805]
[28]
Baron SJ, Wang K, House JA, et al. Cost-effectiveness of transcatheter vs. surgical aortic valve replacement in patients with severe aortic stenosis at intermediate risk. Circulation 2019; 139(7): 877-88.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.118.035236] [PMID: 30586747]
[29]
Bosch J, O’Donnell M, Swaminathan B, et al. Effects of blood pressure and lipid lowering on cognition: Results from the HOPE-3 study. Neurology 2019; 92(13): e1435-46.
[http://dx.doi.org/10.1212/WNL.0000000000007174] [PMID: 30814321]
[30]
English WJ, Williams DB. Metabolic and bariatric surgery: An effective treatment option for obesity and cardiovascular disease. Prog Cardiovasc Dis 2018; 61(2): 253-69.
[http://dx.doi.org/10.1016/j.pcad.2018.06.003] [PMID: 29953878]
[31]
Romeo S, Maglio C, Burza MA, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care 2012; 35(12): 2613-7.
[http://dx.doi.org/10.2337/dc12-0193] [PMID: 22855732]
[32]
Sheka AC, Wirth KM, Ikramuddin S. Preventing macrovascular events with bariatric surgery. JAMA 2018; 320(15): 1545-7.
[http://dx.doi.org/10.1001/jama.2018.14639] [PMID: 30326109]
[33]
Beamish AJ, Olbers T, Kelly AS, Inge TH. Cardiovascular effects of bariatric surgery. Nat Rev Cardiol 2016; 13(12): 730-43.
[http://dx.doi.org/10.1038/nrcardio.2016.162] [PMID: 27762312]
[34]
Billeter AT, de la Garza Herrera JR, Scheurlen KM, Nickel F, Billmann F, Müller-Stich BP. management of endocrine disease: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass. Eur J Endocrinol 2018; 179(2): R77-93.
[http://dx.doi.org/10.1530/EJE-18-0009] [PMID: 29764908]
[35]
Adams TD, Arterburn DE, Nathan DM, Eckel RH. Clinical outcomes of metabolic surgery: Microvascular and macrovascular complications. Diabetes Care 2016; 39(6): 912-23.
[http://dx.doi.org/10.2337/dc16-0157] [PMID: 27222549]
[36]
Quevedo MDP, Palermo M, Serra E, Ackermann MA. Metabolic surgery: Gastric bypass for the treatment of type 2 diabetes mellitus. Transl Gastroenterol Hepatol 2017; 2: 58.
[http://dx.doi.org/10.21037/tgh.2017.05.10] [PMID: 28713862]
[37]
Guilbert L, Ortiz CJ, Espinosa O, et al. Metabolic syndrome 2 years after laparoscopic gastric bypass. Int J Surg 2018; 52: 264-8.
[http://dx.doi.org/10.1016/j.ijsu.2018.02.056] [PMID: 29501798]
[38]
Abdelaal M, le Roux CW, Docherty NG. Validated scoring systems for predicting diabetes remission after bariatric surgery. Bariatr Surg Pract Patient Care 2017; 12(4): 153-61.
[http://dx.doi.org/10.1089/bari.2017.0034]
[39]
Auclair A, Martin J, Bastien M, et al. Is there a role for visceral adiposity in inducing type 2 diabetes remission in severely obese patients following biliopancreatic diversion with duodenal switch surgery? Obes Surg 2016; 26(8): 1717-27.
[http://dx.doi.org/10.1007/s11695-015-1973-3] [PMID: 26660319]
[40]
Berggren J, Lindqvist A, Hedenbro J, Groop L, Wierup N. Roux-en-Y gastric bypass versus calorie restriction: Support for surgery per se as the direct contributor to altered responses of insulin and incretins to a mixed meal. Surg Obes Relat Dis 2017; 13(2): 234-42.
[http://dx.doi.org/10.1016/j.soard.2016.09.017] [PMID: 27894746]
[41]
Duffey BG, Alanee S, Pedro RN, et al. Hyperoxaluria is a long-term consequence of Roux-en-Y Gastric bypass: A 2-year prospective longitudinal study. J Am Coll Surg 2010; 211(1): 8-15.
[http://dx.doi.org/10.1016/j.jamcollsurg.2010.03.007] [PMID: 20610243]
[42]
Liang Z, Wu Q, Chen B, Yu P, Zhao H, Ouyang X. Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Diabetes Res Clin Pract 2013; 101(1): 50-6.
[http://dx.doi.org/10.1016/j.diabres.2013.04.005] [PMID: 23706413]
[43]
Sinha MK, Collazo-Clavell ML, Rule A, et al. Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney Int 2007; 72(1): 100-7.
[http://dx.doi.org/10.1038/sj.ki.5002194] [PMID: 17377509]
[44]
Osland E, Yunus RM, Khan S, Memon B, Memon MA. Changes in non-diabetic comorbid disease status following laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic Roux-En-Y gastric bypass (LRYGB) procedures: A systematic review of randomized controlled trials. Obes Surg 2017; 27(5): 1208-21.
[http://dx.doi.org/10.1007/s11695-016-2469-5] [PMID: 27896647]
[45]
Halperin F, Ding SA, Simonson DC, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: Feasibility and 1-year results of a randomized clinical trial. JAMA Surg 2014; 149(7): 716-26.
[http://dx.doi.org/10.1001/jamasurg.2014.514] [PMID: 24899464]
[46]
Ikramuddin S, Korner J, Lee WJ, et al. Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin A1c, LDL cholesterol, and systolic blood pressure at 5 years in the Diabetes Surgery Study. JAMA 2018; 319(3): 266-78.
[http://dx.doi.org/10.1001/jama.2017.20813] [PMID: 29340678]
[47]
Raveendran AV, Shiji PV, Pappachan JM. Role of bariatric surgery in type 2 diabetes. BMH Med J 2017; 4(1): 6-16.
[48]
Salinari S, Bertuzzi A, Guidone C, Previti E, Rubino F, Mingrone G. Insulin sensitivity and secretion changes after gastric bypass in normotolerant and diabetic obese subjects. Ann Surg 2013; 257(3): 462-8.
[http://dx.doi.org/10.1097/SLA.0b013e318269cf5c] [PMID: 23388352]
[49]
Xanthakos SA, Jenkins TM, Kleiner DE, et al. High prevalence of nonalcoholic fatty liver disease in adolescents undergoing bariatric surgery. Gastroenterology 2015; 149(3): 623-34.e8.
[http://dx.doi.org/10.1053/j.gastro.2015.05.039] [PMID: 26026390]
[50]
Bischoff SC, Boirie Y, Cederholm T, et al. Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clin Nutr 2017; 36(4): 917-38.
[http://dx.doi.org/10.1016/j.clnu.2016.11.007] [PMID: 27890486]
[51]
João AL, Reis F, Fernandes R. The incretin system ABCs in obesity and diabetes - novel therapeutic strategies for weight loss and beyond. Obes Rev 2016; 17(7): 553-72.
[http://dx.doi.org/10.1111/obr.12421] [PMID: 27125902]
[52]
Le Jemtel TH, Samson R, Milligan G, Jaiswal A, Oparil S. Visceral adipose tissue accumulation and residual cardiovascular risk. Curr Hypertens Rep 2018; 20(9): 77.
[http://dx.doi.org/10.1007/s11906-018-0880-0] [PMID: 29992362]
[53]
Marchesini G, Petta S, Dalle Grave R. Diet, weight loss, and liver health in nonalcoholic fatty liver disease: Pathophysiology, evidence, and practice. Hepatology 2016; 63(6): 2032-43.
[http://dx.doi.org/10.1002/hep.28392] [PMID: 26663351]
[54]
Lemanu DP, Singh PP, Rahman H, Hill AG, Babor R, MacCormick AD. Five-year results after laparoscopic sleeve gastrectomy: A prospective study. Surg Obes Relat Dis 2015; 11(3): 518-24.
[http://dx.doi.org/10.1016/j.soard.2014.08.019] [PMID: 25614352]
[55]
Ponnusamy V, Owens AP, Purkayastha S, Iodice V, Mathias CJ. Orthostatic intolerance and autonomic dysfunction following bariatric surgery: A retrospective study and review of the literature. Auton Neurosci 2016; 198: 1-7.
[http://dx.doi.org/10.1016/j.autneu.2016.05.003] [PMID: 27292926]
[56]
Agrò FE, Vennari M, Centonze A. Postoperative renal management, fluid/electrolyte management and acid-base disorders Congenital heart disease in pediatric and adult patients: Anesthetic and perioperative management. Cham: Springer 2017; pp. 889-950.
[http://dx.doi.org/10.1007/978-3-319-44691-2_40]
[57]
Ghanim H, Monte S, Caruana J, Green K, Abuaysheh S, Dandona P. Decreases in neprilysin and vasoconstrictors and increases in vasodilators following bariatric surgery. Diabetes Obes Metab 2018; 20(8): 2029-33.
[http://dx.doi.org/10.1111/dom.13320] [PMID: 29652095]
[58]
Priester T, Ault TG, Davidson L, et al. Coronary calcium scores 6 years after bariatric surgery. Obes Surg 2015; 25(1): 90-6.
[http://dx.doi.org/10.1007/s11695-014-1327-6] [PMID: 24927692]
[59]
Wentworth JM, Playfair J, Laurie C, et al. Multidisciplinary diabetes care with and without bariatric surgery in overweight people: A randomised controlled trial. Lancet Diabetes Endocrinol 2014; 2(7): 545-52.
[http://dx.doi.org/10.1016/S2213-8587(14)70066-X] [PMID: 24731535]
[60]
Yilmaz H, Ece I, Sahin M. Revisional surgery after failed laparoscopic sleeve gastrectomy: Retrospective analysis of causes, results, and technical considerations. Obes Surg 2017; 27(11): 2855-60.
[http://dx.doi.org/10.1007/s11695-017-2712-8] [PMID: 28493043]
[61]
Carlsson LMS, Sjöholm K, Karlsson C, et al. Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycaemic status: A post-hoc analysis of participants from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol 2017; 5(4): 271-9.
[http://dx.doi.org/10.1016/S2213-8587(17)30061-X] [PMID: 28237791]
[62]
Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 2014; 311(22): 2297-304.
[http://dx.doi.org/10.1001/jama.2014.5988] [PMID: 24915261]
[63]
Ho M, Garnett SP, Baur L, et al. Effectiveness of lifestyle interventions in child obesity: Systematic review with meta-analysis. Pediatrics 2012; 130(6): e1647-71.
[http://dx.doi.org/10.1542/peds.2012-1176] [PMID: 23166346]
[64]
Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study. Obesity (Silver Spring) 2014; 22(1): 5-13.
[http://dx.doi.org/10.1002/oby.20662] [PMID: 24307184]
[65]
Ricci C, Gaeta M, Rausa E, Asti E, Bandera F, Bonavina L. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: A meta-analysis and meta-regression study with 5-year follow-up. Obes Surg 2015; 25(3): 397-405.
[http://dx.doi.org/10.1007/s11695-014-1442-4] [PMID: 25240392]
[66]
Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: Cardiovascular disease in diabetes mellitus: Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus - mechanisms, management, and clinical considerations. Circulation 2016; 133(24): 2459-502.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.116.022194] [PMID: 27297342]
[67]
Bays HE, Toth PP, Kris-Etherton PM, et al. Obesity, adiposity, and dyslipidemia: A consensus statement from the National Lipid Association. J Clin Lipidol 2013; 7(4): 304-83.
[http://dx.doi.org/10.1016/j.jacl.2013.04.001] [PMID: 23890517]
[68]
Kapa S, Sert Kuniyoshi FH, Somers VK. Sleep apnea and hypertension: Interactions and implications for management. Hypertension 2008; 51(3): 605-8.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.106.076190] [PMID: 18227409]
[69]
Maessen DE, Stehouwer CD, Schalkwijk CG. The role of methylglyoxal and the glyoxalase system in diabetes and other age-related diseases. Clin Sci (Lond) 2015; 128(12): 839-61.
[http://dx.doi.org/10.1042/CS20140683] [PMID: 25818485]
[70]
Coutinho T, Goel K, Corrêa de Sá D, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: Role of “normal weight central obesity”. J Am Coll Cardiol 2013; 61(5): 553-60.
[http://dx.doi.org/10.1016/j.jacc.2012.10.035] [PMID: 23369419]
[71]
Ding S, Deng Y, Lu S, Lamb KV, Zhang Y, Wu Y. Knowledge and practice in cardiovascular disease prevention among hospital registered nurses: A cross-sectional study. J Clin Nurs 2017; 26(21-22): 3318-27.
[http://dx.doi.org/10.1111/jocn.13678] [PMID: 27906479]
[72]
Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 1992; 16(6): 397-415.
[PMID: 1322866]
[73]
Gooneratne NS. Sleep apnea in older adultsSleep apnea: Pathogenesis, diagnosis and treatment. 2nd ed. London: Informa Healthcare 2012; pp. 399-417.
[74]
Ekström N, Svensson AM, Miftaraj M, et al. Cardiovascular safety of glucose-lowering agents as add-on medication to metformin treatment in type 2 diabetes: Report from the Swedish National Diabetes Register. Diabetes Obes Metab 2016; 18(10): 990-8.
[http://dx.doi.org/10.1111/dom.12704] [PMID: 27282621]
[75]
Mauricio MD, Aldasoro M, Ortega J, Vila JM. Endothelial dysfunction in morbid obesity. Curr Pharm Des 2013; 19(32): 5718-29.
[http://dx.doi.org/10.2174/1381612811319320007] [PMID: 23448493]
[76]
Wadhera RK, Steen DL, Khan I, Giugliano RP, Foody JM. A review of low-density lipoprotein cholesterol, treatment strategies, and its impact on cardiovascular disease morbidity and mortality. J Clin Lipidol 2016; 10(3): 472-89.
[http://dx.doi.org/10.1016/j.jacl.2015.11.010] [PMID: 27206934]
[77]
Sanchis P, Frances C, Nicolau J, et al. Cardiovascular risk profile in Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention: Impact of both interventions after 1 year of follow-up. Obes Surg 2015; 25(1): 97-108.
[http://dx.doi.org/10.1007/s11695-014-1321-z] [PMID: 24908246]
[78]
Campbell TC, Campbell TM II. Eating right: Eight principles of food and healthThe China study: The most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss, and long-term health Revised and expanded edition. BenBella Books 2016; pp. 225-41.
[79]
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384(9945): 766-81.
[http://dx.doi.org/10.1016/S0140-6736(14)60460-8] [PMID: 24880830]
[80]
Clemens R, Pressman P. Nutritional and dietary supplements: Code or concernPreventive nutrition: The comprehensive guide for health professionals. 5th ed. New York: Springer 2015; pp. 47-62.
[http://dx.doi.org/10.1007/978-3-319-22431-2_3 ]

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