Bariatric surgery attenuates the age-related increase in cardiovascular risk over 10 years

Background and aims: Bariatric surgery (BS) improves cardiovascular risk (CVR) profiles in the short to mid-term, but long-term data remain limited. This study evaluated the 10-year evolution of estimated CVR in Mediterranean patients with obesity undergoing BS, using the Registre Gironí del Cor (REGICOR) and SCORE2 models. Methods and results: A retrospective cohort study included 128 patients who underwent BS (laparoscopic sleeve gastrectomy [LSG] or laparoscopic Roux-en-Y gastric bypass [LRYGB]) between 2004 and 2012, with 10-year follow-up. CVR was estimated at baseline, 1, 5, and 10 years using REGICOR and SCORE2. Simulation analyses aimed to isolate the effect of aging from changes in cardiometabolic parameters. The cohort (86.7% women; mean age 46.8 ± 8.0 years; baseline BMI 44.4 ± 4.8 kg/m²) showed significant CVR reduction at 1 year: REGICOR decreased from 3.48 ± 0.58% to 1.86 ± 0.34% (p < 0.001), SCORE2 from 2.67 ± 0.28% to 2.33 ± 0.24% (p = 0.001). At 10 years, REGICOR returned to baseline (3.15 ± 0.60%, p = 0.999), while SCORE2 increased to 4.05 ± 0.48% (p < 0.001). Simulation analyses suggested that aging might be one of the main contributors to the long-term increase in CVR. LRYGB was associated with a more favourable SCORE2 trajectory than LSG. Conclusion: BS confers sustained long-term benefit on estimated CVR. Despite patients being 10 years older, CVR remained close to preoperative levels, suggesting a potential attenuation of the expected age-related increase in risk.