Resumen Introducción: la obesidad mórbida es una enfermedad de etiología multifactorial, de gran prevalencia en el mundo, que guarda relación directa con otras comorbilidades. Objetivo: analizar las respuestas cardiovasculares de pacientes mujeres con obesidad mórbida, a través de un test de esfuerzo máximo para la estratificación del riesgo y la prescripción de ejercicio. Método: se incluyeron trece pacientes con obesidad grado III, de sexo femenino, con edad entre 20 a 40 años, que fueron sometidas a un test ergoespirométrico en el cicloergómetro de miembros superiores para la verificación y el análisis de la frecuencia cardiaca, la presión arterial y el doble producto. Resultados: las pacientes con media de edad de 34,7 ± 5,1 años tenían índice de masa corporal de 46,5 ± 3,8 kg/m2. Alcanzaron una frecuencia cardíaca máxima de 168,2 ± 14,6 lpm, sin respuesta hipertensiva al esfuerzo, y presión arterial de 171,1 ± 22,2 mm Hg (sistólica) x 87,5 ± 4,2 mm Hg (diastólica). El doble producto máximo encontrado fue de 28.662,2 ±3.644,1 mm Hg.lpm. Conclusión: de acuerdo con los resultados de este estudio se observó una reducción de la frecuencia cardiaca, la presión arterial y el doble producto cardiaco, compatible con el esfuerzo esperado para el test.

Abstract Introduction: Morbid obesity is a condition of multifactorial origin with a high prevalence worldwide, and has a direct relationship with other illnesses. Objective: To analyse the cardiovascular responses of morbid obese women using a máximum stress test for stratifying risk and the prescribing of exercise. Method: The study included 13 patients with Grade III obesity. All were women between 20 and 40 years of age. Their arms were subjected to an ergospirometry test on the cycle ergometry in order to check and analyse heart rate, blood pressure, and the double product. Results: The patients had a mean age of 34.7 ± 5.1 years, and a mean body mass index of46.5 ± 3.8 kg/m2. A maximum heart rate of 168.2 ± 14.6 bpm was achieved, with no hypertensive response to the stress, and blood pressure of 171.1 ± 22.2 mm Hg (systolic) x 87.5 ± 4.2 mm Hg (diastolic). The maximum double product found was 28,662.2 ±3,644.1 mm Hg.bpm. Conclusion: In the results of this study is observed reduction of heart rate, blood pressure, and the double cardiac product, compatible with the expected effort for the test.

RESUMO Racional: Em função do alto grau de falência que se observa no tratamento clínico da obesidade mórbida, observa-se um aumento da procura pela cirurgia bariátrica como alternativa para o controle da obesidade e comorbidades. Objetivo: Avaliar a evolução do diabete melito tipo 2, da hipertensão arterial sistêmica e da dislipidemia em pacientes submetidos à gastroplastia redutora em Y-de-Roux no período de pós-operatório tardio. Métodos: Análise retrospectiva de 59 pacientes inseridos em programa de cirurgia bariátrica. Foram coletados dados antropométricos (altura e peso corporal) e laboratoriais (LDLc, HDLc, VLDLc, triglicerídeo -TG - e glicose) nos períodos pré e pós-operatório por meio de prontuários médicos. Resultados: Entre os pacientes, 86% eram mulheres com idade de 43±11 anos e 52% tinham cursado o ensino médio. O tempo médio de pós-operatório foi de 7±3 anos. Houve redução no peso e no índice de massa corporal no pós-operatório, respectivamente (133±06 kg vs 91±04 kg p<0,05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0,05). Observou-se concentrações inferiores no pós-operatório, comparado com o pré-operatório, da glicose (101,00±26,99 vs 89,11±15,19, p=0,014), colesterol total (179,00±37,95 vs 167,48±28,50, p=0,016), LDLc (104,30±33,12 vs 91,46±24,58, p=0,016), VLDLc (25,40±11,12 vs 15,68±7,40, p<0,01), e TG (143,35±86,35 vs 82,45±37,39, p<0,01) e maiores de HDLc (43,53±8,23 vs 57,90±15,60, p<0,01 ). No pós-operatório 40% dos pacientes hipertensos ainda estavam em tratamento para hipertensão arterial sistêmica. Houve remissão do diabete melito tipo 2 e da dislipidemia em 81% e 94% dos casos, respectivamente. Conclusão: A gastroplastia redutora em Y-de-Roux mostrou ser procedimento eficaz em longo prazo, com resultados persistentes na perda de peso, remissão do DM2 e da dislipidemia.

ABSTRACT Background: Due to the high failure rate observed in the clinical treatment of morbid obesity an increase in bariatric surgery indications, as an alternative for the control of obesity and comorbidities, is noticeable. Aim: To evaluate the performance of type 2 diabetes mellitus, high blood pressure and dyslipidemia in patients submitted to Roux-en-Y gastric bypass in late follow-up. Methods: Retrospective analysis of 59 patients included in the bariatric surgery program. Anthropometric (height and body weight) and laboratory (LDLc, HDLc, VLDLc, triglyceride -TG - and glucose) data were collected on pre- and postoperative stages, through medical records. Results: Among the patients, 86% were female aged 43±11, of whom 52% had attended high school. The average postoperative time was 7±3 years. During the postoperative period, there were decreases of weight and body mass index, respectively (133±06 kg vs 91±04 kg p<0.05 e 49±74 kg/m2 vs 33±79 kg/m2, p<0.05). In comparison to the preoperative stage, lower concentrations of glucose (101.00±26.99 vs 89,11±15.19, p=0.014), total cholesterol rates (179.00±37,95 vs 167.48±28,50, p=0.016), LDLc (104.30±33.12 vs 91.46±24.58, p=0.016), VLDLc (25.40±11,12 vs 15.68±7.40, p<0.01), and TG (143.35±86.35 vs 82.45±37.39, p<0.01) and higher concentrations of HDLc (43.53±8.23 vs 57.90±15.60, p<0.01) were identified in the postoperative stage. 40% of hypertensive patients were still undergoing high blood pressure treatment during the postoperative stage. There was remission of type 2 diabetes mellitus and dyslipidemia on 81% and 94% of the cases, respectively. Conclusion: Roux-en-Y gastric bypass has proven itself to be an effective long term procedure, promoting weight loss, remission of DM2 and dyslipidemia.