Background <p>Cardiovascular disease (CVD) is the main cause of death in patients with obesity. Bariatric surgery has been shown to promote substantial reduction in carotid intima-media thickness (C-IMT).</p> Aim <p>To comprehensively determine the influence of metabolic and bariatric surgery (MBS) on cardiovascular health in women.</p> Methods <p>A total of 24 female patients with a body mass index (BMI) &gt; 35&#xa0;kg/m² underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one anastomosis gastric bypass (OAGB), a prospective cohort study in women. C-IMT were evaluated at baseline and 24&#xa0;months post-MBS.</p> Results <p>The results showed a significant reduction in BMI, weight, and C-IMT on the right side 24&#xa0;months post-MBS (<i>p</i> &lt; 0.001 for BMI and weight and <i>p</i> = 0.004 for C-IMT). There were also significant differences in fasting blood sugar (FBS), triglycerides (TG), total cholesterol, and low-density lipoprotein (LDL) levels. However, high-density lipoprotein (HDL) levels did not show a significant change.</p> Conclusion <p>The study underscores the potential of MBS in mitigating cardiovascular risk among women with obesity. However, further research is needed to fully understand the impact of MBS on various parameters. The findings highlight the importance of personalized and gender-specific approaches in the management of obesity and related disease.</p> Graphical abstract <p></p>