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ISSN 2522-9028 (Print)
ISSN 2522-9036 (Online)

Fiziologichnyi Zhurnal

is a scientific journal issued by the

Bogomoletz Institute of Physiology
National Academy of Sciences of Ukraine

Editor-in-chief: V.F. Sagach

The journal was founded in 1955 as
1955 – 1977 "Fiziolohichnyi zhurnal" (ISSN 0015 – 3311)
1978 – 1993 "Fiziologicheskii zhurnal" (ISSN 0201 – 8489)
1994 – 2016 "Fiziolohichnyi zhurnal" (ISSN 0201 – 8489)
2017 – "Fiziolohichnyi zhurnal" (ISSN 2522-9028)

Fiziol. Zh. 2021; 67(5): 64-72


V.V. Gorbachova, I.M. Todurov, O.I. Plegutsa, K.M. Khorevina, О.О. Kalashnikov

    Center of innovative medical technologies NAS of Ukraine, Kyiv, Ukraine


Obesity is an established risk factor for cardiovascular diseases (CVD) such as hypertension (HD), coronary artery disease (CAD), heart failure (HF), arrhythmias and venous thromboembolism. Lifestyle modifications to reduce weight have been shown to be successful in the short term, however their long-term results are still equivocal likely due to modest weight reduction and high recurrence rates. Bariatric surgery has been recognized as the most effective strategy in achieving substantial sustained weight loss, and can prevent the development or reverse CVD, metabolic syndrome, diabetes mellitus, obstructive sleep apnea syndrome, cancer, and COVID-associated complications. Bariatric surgery results in rapid weight loss over several months that lasts for at least 12-18 months. The surgery lowers all-cause mortality risks, risks of myocardial infarction and stroke. Furthermore, bariatric surgery contributes to the reduction of urgent hospitalizations for heart failure, coronary artery disease, and hypertension. The article shows modern view on the impact of bariatric surgery on the pathogenesis of the CVD in patients with obesity, indications and contraindications of the surgery, tactics of management of patients with existing cardiovascular pathology before the bariatric surgery.

Keywords: obesity; morbid obesity; cardiovascular diseases; atherosclerosis; bariatric surgery


  1. Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K; GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017;377:13-27. CrossRef PubMed PubMedCentral
  2. Ukrainian Government Statistic Service. Social and Demographic Characteristics of Households of Ukraine 2020. Statistic Digest. 2020.
  3. World Health Organization Technical Report 894. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization, 2000.
  4. Jastreboff AM, Kotz CM, Kahan S, Kelly AS, Heymsfield SB. Obesity as a disease: The obesity society 2018 position statement. Obesity (Silver Spring). 2019;27:7-9. CrossRef PubMed
  5. Wong CX, Sullivan T, Sun MT, Mahajan R, Pathak RK. Obesity and the risk of incident, post-operative, and postablation atrial fibrillation: a meta-analysis of 626,603 individuals in 51 studies. JACC Clin Electrophysiol. 2015;1:139-52. CrossRef PubMed
  6. Powell-Wiley MT, Poirier P, Burke L, Després JP, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge MP, on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. Obesity and Cardiovascular Disease A Scientific Statement from the American Heart Association. Circulation. 2021;143. CrossRef PubMed PubMedCentral
  7. Cardel MI, Atkinson MA, Taveras EM, Holm JC, Kelly AS. Obesity treatment among adolescents: a review of current evidence and future directions. JAMA Pediatr. 2020;174:609-17. CrossRef PubMed PubMedCentral
  8. Krushnapriya S, Bishnupriya S, Ashok KC, Nighat YS, Raman K, and Ajeet SB. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015 Apr-Jun; 4(2): 187-92. CrossRef PubMed PubMedCentral
  9. Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation 2008;117:1658-67 CrossRef PubMed
  10. Shah RV, Murthy VL, Abbasi SA, Blankstein R, Kwong RY, et al. Visceral adiposity and the risk of metabolic syndrome across body mass index: the MESA study. J Am Coll Cardiol Cardiovascul Image. 2014;7:1222-35. CrossRef PubMed PubMedCentral
  11. Kloting N, Bluher M. Adipocyte dysfunction, inflammation and metabolic syndrome. Rev Endocrinol Metab Disord. 2014;15:277-87. CrossRef PubMed
  12. Chumakova GA, Kuznetsova ТY, Druzhilov МА, Veselovskaya NG. Visceral adiposity as a global factor of cardiovascular risk. Rush J Cardiol. 2018; 23 (5): 7-14. CrossRef
  13. Abraham TM, Pedley A, Massaro JM, Hoffmann U, Fox CS. Association between visceral and subcutaneous adipose depots and incident cardiovascular disease risk factors. Circulation. 2015;132:1639-47. CrossRef PubMed PubMedCentral
  14. Tatsumi Y, Nakao YM, Masuda I, Higashiyama A, Takegami M. Risk for metabolic diseases in normal weight individuals with visceral fat accumulation: a crosssectional study in Japan. BMJ Open. 2017;7:e013831. CrossRef PubMed PubMedCentral
  15. Fox CS, Massaro JM, Hoffmann U, Pou KM, MaurovichHorvat P. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39-48. CrossRef PubMed
  16. Britton KA, Massaro JM, Murabito JM, Kreger BE, Hoffmann U, Fox CS. Body fat distribution, incident cardiovascular disease, cancer, and all cause mortality. J Am Coll Cardiol. 2013;62:921-25. CrossRef PubMed PubMedCentral
  17. Neeland IJ, Ayers CR, Rohatgi AK, Turer AT, Berry JD. Associations of visceral and abdominal subcutaneous adipose tissue with markers of cardiac and metabolic risk in obese adults. Obesity (Silver Spring). 2013;21:E439-47. CrossRef PubMed PubMedCentral
  18. Després JP. Body fat distribution and risk of cardiovascular disease: an update. Circulation. 2012;126:1301-13. CrossRef PubMed
  19. Lavie CJ, Alpert MA, Arena R. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail. 2013;1:93-102. CrossRef PubMed
  20. Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444:875-80 CrossRef PubMed
  21. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67:968-77. CrossRef PubMed
  22. Wannamethee SG, Shaper AG, Whincup PH. Obesity and risk of incident heart failure in older men with and without pre-existing coronary heart disease: does leptin have a role? J Am Coll Cardiol. 2011,58:1870-77. CrossRef PubMed
  23. Lau DH, Nattel S, Kalman JM, Sanders P. Modifiable risk factors and atrial fibrillation. Circulation. 2017;136:583-96. CrossRef PubMed
  24. Middeldorp ME, Pathak RK, Meredith M, Mehta AB, Elliott AD. Prevention and regressive effect of weightloss and risk factor modification on atrial fibrillation: the reverse-AF study. Europace. 2018;20:1929-35. CrossRef PubMed
  25. Hindricks G, Potpara Т, Dagres N, Arbelo E, Bax JJ. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020 1126 ESC GUIDELINES.
  26. Duflou J, Virmani R, Rabin I, Burke A, Farb A, Smialek J. Sudden death as a result of heart disease in morbid obesity. Am Heart J. 1995;130:306-13. CrossRef
  27. Sabbag A, Goldenberg I, Moss AJ, McNitt S, Glikson M, et al. Predictors and risk of ventricular tachyar rhythmias or death in black and white cardiac patients: a MADITCRT Trial substudy. JACC Clin Electrophysiol. 2016;2:448-55. CrossRef PubMed
  28. Sundstrom J, Bruze G, Ottosson J, Marcus C, Naslund I, Neovius M. Weight loss and heart failure: a nationwide study of gastric bypass surgery versus intensive lifestyle treatment. Circulation. 2017;135:1577-85. CrossRef PubMed PubMedCentral
  29. Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and metaanalysis of randomized controlled trials. BMJ. 2013;347. CrossRef PubMed PubMedCentral
  30. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an openlabel, single-centre, randomized controlled trial. Lancet. 2015;386:964-73. CrossRef
  31. Csige I, Ujvárosy D, Szabó Z, Lőrincz I, Paragh G. The impact of obesity on the cardiovascular system. J Diabet Res. 2018 Article ID 3407306. CrossRef PubMed PubMedCentral
  32. Kuno T, Tanimoto E, Morita S, Shimada YJ. Effects of bariatric surgery on cardiovascular disease: A concise update of recent advances. Front Cardiovascul Med. 6:94. CrossRef PubMed PubMedCentral
  33. Jamaly S, Carlsson L, Peltonen M, Jacobsen P, Karason K. Surgical obesity treatment and the risk of heart failure. Eur Heart J. 2019;40:2131-8. CrossRef PubMed PubMedCentral
  34. Jamaly S, Carlsson L, Peltonen M, Jacobson P, Karason K. Surgical obesity treatment and the risk of heart failure. Eur Heart J. 2019;40,2131-8. CrossRef PubMed PubMedCentral
  35. Hutan A, Carel W le Roux, Ara Darzi. Thanos Athanasiou. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118:2091-102. CrossRef PubMed
  36. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007 357:741-52. CrossRef PubMed
  37. Beamish AJ, Olbers T, Kelly AS and Inge TH. Cardiovascular effects of bariatric surgery. Nat Rev: Cardiol. 2016 Oct; 20. CrossRef PubMed
  38. Mechanick J, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. American Association of Clinical Endocrinologists; Obesity Society;American Society for Metabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. 2013 Mar-Apr;19(2):337-72. CrossRef PubMed PubMedCentral
  39. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37;27:2129-200. CrossRef PubMed
  40. Vest AR, Chan M, Deswal A, Givertz MM, Lekavich C. Nutrition, obesity, and cachexia in patients with heart failure: a consensus statement from the Heart Failure Society of America Scientific Statements Committee. J Card Fail. 2019;25:380-400. CrossRef PubMed
  41. Poirier P, Cornier MA., Mazzone T, Stiles S, Cummings S. Bariatric surgery and cardiovascular risk factors. A scientific statement from the American Heart Association. Circulation. 2011;123:1683-701. CrossRef PubMed
  42. Kuno T, Tanimoto Е, Morita S, and Shimada YJ. Effects of bariatric surgery on cardiovascular disease: A concise update of recent advances. Front Cardiovascul Med. 2019;6: Article 94. CrossRef PubMed PubMedCentral
  43. Gourash WF, Ebel F, Lancaster K, Adeniji A, Iacono LK, Eagleton JK, McDougall A, Cassady C, Ericson H, Pories W, Wolfe BM, Belle SH. LABS Consortium Retention Writing Group. Longitudinal Assessment of Bariatric Surgery (LABS): retention strategy and results at 24 months. Surg Obes Relat Dis. 2013;9(4):514-9. CrossRef PubMed PubMedCentral
  44. Davis C, Tait G, Carroll J, Wijeysundera DN, Beattie WS. The Revised Cardiac Risk Index in the new millennium: a single-centre prospective cohort re-evaluation of the original variables in 9,519 consecutive elective surgical patients. Can J Anaesth. 2013 Sep;60(9):855-63. CrossRef PubMed
  45. Ramanan B, Gupta PK, Gupta H, Fang X, Forse RA. Development and validation of a bariatric surgery mortality risk calculator. J Am Coll Surg. 2012 Jun;214(6):892-900. CrossRef PubMed
  46. Tognolini A, Arellano CS, Marfori W, Sayre JW, Hollada JL, Goldin JG, Dutson EP, Ruehm SG. Cardiac dual-source CT for the preoperative assessment of patients undergoing bariatric surgery. Clin Radiol. 2013 Mar;68(3):e154-63. CrossRef PubMed
  47. Gugliotti D, Grant P, Jaber W, Aboussouan L, Bae C, Sessler D, Scahuer P, Kaw R. Challenges in cardiac risk assessment in bariatric surgery patients. Obes Surg. 2008 Jan;18(1):129-33. CrossRef PubMed
  48. Ana Alegria-Barrero. Consider bariatric surgery in obese patients. Е-journal of the ESC Council for Cardiology Practice. 2013 Nov;12: 9/19.
  49. Benalcazar DA, Cascella M. Obesity surgery pre-op assessment and preparation. books/NBK546667/
  50. Kwon S, Thompson R, Florence M. β-Blocker Continuation After Noncardiac Surgery A Report From the Surgical Care and Outcomes Assessment Program. Arch Surg. 2012;147(5):467-73. CrossRef PubMed PubMedCentral
  51. Li W, Gorecki P, Semaan E, Briggs W, Tortolani AJ, D'Ayala M. Concurrent prophylactic placement of inferior vena cava filter in gastric bypass and adjustable banding operations in the bariatric outcomes longitudinal database. J Vascul Surg. 2012 Jun;55(6):1690-5. CrossRef PubMed
  52. Flores RM, Salinas AC, Piché ME, Auclair A, Poirier P. Effect of bariatric surgery on heart failure. Exp Rev Cardiovascul Ther. 2017;15:567-79. CrossRef PubMed

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