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655 In this issue of Kardiologia Polska (Kardiol Pol, Polish Heart Journal), Kaya et al7 illustrated the re­ sults of their prospective study including 71 pa­ tients affected by morbid obesity undergoing LSG, with the aim of analyzing the effects of this bar­ iatric procedure on atherosclerotic vascular dis­ ease. To do so, authors specifically assessed mul­ tiple surrogate markers commonly used to eval­ uate the atherosclerotic burden, namely, aor­ tic propagation velocity (APV), carotid intima­ ­media thickness (CIMT), ankle ­brachial index (ABI), and epicardial fat thickness. Emerging data from this study highlighted a significant reduc­ tion of body weight, additionally to a substan­ tial improvement in all examined atheroscle­ rotic markers 6 months after LSG. In particular, authors found a significant increase in APV and ABI, together with a reduction of CIMT, epicar­ dial fat thickness, systolic and diastolic blood pressure, triglyceride and low ­density lipopro­ tein cholesterol levels. These results were strong­ ly correlated with the degree of weight loss (ie, Δ body mass index). Such correlation allows to infer that the beneficial effects of LSG on atheroscle­ rotic vascular disease markers are largely medi­ ated by the entity of weight reduction obtained through surgery. In fact, in this regard, the au­ thors assert that body mass index is a fundamen­ tal predictor for both changes in APV and CIMT. A limited number of studies have described the positive long ­term effects of different types of BMS procedures on reverse cardiac remodel­ ing and cardiovascular events which occur conse­ quently to considerable body weight reduction.8‐10 In particular, our group previously analyzed in a retrospective study the echocardiographic and metabolic changes occurring 16 months after Overweight and obesity have reached pandemic proportions worldwide, affecting 39% and 13% of the adult population, respectively.1 Obesity is associated with the development of an array of metabolic complications, including insulin resistance, type 2 diabetes, hypertension, and dyslipidemia, which are correlated with an in­ creased overall cardiovascular risk. Further­ more, obesity is regarded as an independent risk factor for cardiovascular disease (CVD), which may endure additive effects with the coexist­ ing obesity ­related disturbances, translating into the main cause of reduced overall survival rates in such individuals.2 Bariatric and metabolic surgery (BMS) has been extensively demonstrated to be the only ef­ fective treatment modality to date able to gener­ ate substantial and durable weight loss and reso­ lution or improvement of comorbidities.3 Bariat­ ric and metabolic surgery has been also specif­ ically shown to decrease cardiovascular events in the long term as well as the associated mor­ biditiy and mortality, altogether reducing the related economic burden.4 Laparoscopic sleeve gastrectomy (LSG) is by all means the most com­ monly executed bariatric operation at present due to its proven effectiveness in terms of both weight and metabolic outcomes, deemed super­ imposable to those of other long ­standing bar­ iatric procedures such as Roux ­en ­Y gastric by­ pass.3 Moreover, LSG is now undoubtedly rec­ ognized as a metabolic procedure, and not as a merely restrictive one, since it is endowed with the capacity to induce the resolution of obesity­ ­related metabolic complications—especially in­ sulin resistance—before any substantial weight loss has been reached.5,6 Correspondence to: Giovanni Casella, MD, PhD, Department of Surgical Sciences, ”Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy, phone: +39 0649975515, email: [email protected] Received: May 6, 2020. Accepted: May 7, 2020. Published online: August 25, 2020. Kardiol Pol. 2020; 78 (7‐8): 655‐656 doi:10.33963/KP.15560 Copyright by the Author(s), 2020 E D I T O R I A L