DALLAS, October 26, 2020 – People with severe obesity (BMI> 35) and a previous heart attack who undergo weight reduction surgery can reduce the risk of a second heart attack, major cardiovascular event, heart failure and death in compared to people with similar medical histories who have not had weight reduction surgery, according to new research published today in Circulation, the leading newspaper of the American Heart Association.
“It is well known that obesity is associated with an increased risk of type 2 diabetes and heart disease,” said study author Erik Näslund, MD, Ph.D., professor in the department of clinical sciences at Danderyd Hospital, Karolinska Institutet in Sweden. “It has also been shown that weight reduction surgery can improve type 2 diabetes and cardiovascular disease. What has not yet been proven is: if you have had a heart attack, weight reduction surgery can reduce your risk of having another heart attack, which was the focus of our study. “
In the Sweden study, Näslund and colleagues measured the trends between weight loss surgery and subsequent heart attacks, stroke and death in people with severe obesity who had a previous heart attack. The study linked information from two health records – the Swedish Web-System for improving and developing evidence-based care in heart disease assessed according to the recommended therapies registry (SWEDEHEART) and the Scandinavian National Obesity Surgery Registry (SOReg) ).
The researchers compared data from 2005 to 2018 of 509 severely obese patients who had heart attacks with 509 severely obese patients who had heart attacks and subsequently underwent gastric bypass surgery or vertical gastrectomy surgery (the two most common types of surgery weight reduction) between 2007 and 2018. Each patient in the study who underwent weight reduction surgery was paired with a patient who did not undergo surgery and with the same degree of obesity (the mean BMI of both groups was 40) . Patients were also paired according to sex, age, health status and health history.
Patient data were collected over a follow-up period of up to eight years (median 4.6 years), and the researchers statistically analyzed the variables that may have affected the risk of patients who had heart attacks, strokes or died during the monitoring period.
Weight reduction surgery was associated with a lower risk of heart attack and a lower risk of new onset of heart failure, but there was no statistical difference in the risk of stroke between the surgical and non-surgical groups.
Patients who underwent weight reduction surgery had half the risk of death compared to those who did not have surgery.
The rate of serious surgical complications was similar to that seen among patients undergoing weight reduction surgery without previous heart attacks.
Although the weight of patients in the surgery group was significantly lower one year after surgery (mean BMI was 29 after one year), the researchers note that weight loss alone was probably not the driving force in the association between surgery and risk reduction. Additional health changes two years after surgery included:
A large number of surgical patients experienced significant improvements in sleep apnea (67% remission), as well as improvement in hypertension (22% remission), cholesterol and triglyceride levels (29% remission); and
more than half of patients with type 2 diabetes experienced clinical remission of the disease after weight reduction surgery.
The study authors had no information on the patients’ socioeconomic status, and there were no data on weight beyond the two-year follow-up mark for the group that underwent surgery and no weight-tracking data for the non-surgical group. In addition, within the surgery group, there was a substantially greater number of patients who had gastric bypass, so any difference in results between patients with gastric bypass and patients who underwent a vertical gastrectomy procedure could not be assessed. The researchers were also unable to assess whether the time between the heart attack of each patient in the surgery group and weight reduction surgery was a key factor in the complications. A randomized clinical trial is needed to confirm the results of this study.
Co-authors are Erik Stenberg, MD, Ph.D .; Robin Hofmann, MD, Ph.D .; Johan Ottosson, MD, Ph.D .; Magnus Sundbom, MD, Ph.D .; Richard Marsk, MD, Ph.D .; Per Svensson, MD, Ph.D .; Karolina Szummer, MD, Ph.D .; and Tomas Jernberg, MD
This study was funded by grants from the Örebro County Region and the Stockholm County Council in Sweden.
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