Sleeve Gastrectomy is a highly effective intervention for patients with severe obesity, yielding significant improvements in metabolic health and a marked reduction in cardiovascular risk. The detrimental effects of obesity on cardiovascular health are well-documented, with obesity serving as a major contributor to hypertension, diabetes, dyslipidemia, and chronic inflammation, all of which precipitate adverse alterations in cardiac structure and function. Preoperative cardiovascular risk assessment is crucial for stratifying risk and guiding perioperative management. The cardiovascular benefits of sleeve gastrectomy are considerable, encompassing notable improvements in cardiac geometry, diastolic and systolic function, and heart failure markers. Furthermore, it not only diminishes the risk of major adverse cardiovascular events (MACE) in individuals with obesity but also holds promise as a secondary prevention strategy in patients with pre-existing cardiovascular disease.