Abstract

Aim: Bariatric surgery effectively reduces cardiovascular risk, though the mechanisms remain incompletely understood. This study aimed to evaluate changes in Framingham cardiovascular risk scores and identify predictors of risk reduction following sleeve gastrectomy.
Methods: This retrospective cohort study included 111 patients (73% female; median age 33 years (18–63); BMI 43 (35–77) kg/m²) who underwent laparoscopic sleeve gastrectomy between January 2021 and June 2024. Framingham 10-year cardiovascular disease risk scores were calculated at baseline and 12 months postoperatively. Multivariable linear regression identified independent predictors of absolute risk reduction.
Results: The Framingham risk score decreased from 6 (-10–25) to 3 (-9–26) at 12 months (p < 0.001), representing a 50% relative risk reduction. BMI decreased from 43 (35–77) to 29 (21–55) kg/m² (p < 0.001). Notably, BMI change did not correlate with cardiovascular risk reduction (r = 0.032, p = 0.735). HDL cholesterol demonstrated a biphasic trend—initially decreasing at 3 months, then exceeding baseline values at 12 months (p < 0.001). In multivariable analysis, age (β = -0.223, p < 0.001), baseline Framingham score (β = 0.532, p < 0.001), and HDL change (β = 0.279, p = 0.047) were identified as independent predictors of absolute risk reduction. Interestingly, HDL increase showed a negative correlation in univariable but a positive association in multivariable analysis.
Conclusion: Sleeve gastrectomy achieved significant cardiovascular risk reduction independent of weight loss magnitude. The HDL paradox and age-dependent response suggest complex mechanisms beyond simple weight reduction. These findings support incorporating cardiovascular risk assessment, not just BMI, when determining surgical indications.

Key words: Keywords: Sleeve gastrectomy; Framingham risk score; Cardiovascular risk; HDL paradox; Bariatric surgery; Weight loss