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Surgery and heart failure risk

Bariatric surgery reduces heart failure risk in severely obese

Eight years after the weight-loss surgery, 24 people had been diagnosed with heart failure, twice as many - 55 patients in the non-surgery group - developed heart failure

Bariatric surgery reduces the long-term risk of heart failure by more than half in obese patients without a history of heart disease or stroke, according to a study published by researchers from Greisinger Obesity Institute in Danville, PA.

“We were surprised,” said Dr Peter N Benotti, senior clinical investigator at Greisinger Obesity Institute and the study’s lead researcher. “Ours is the first published study to show that bariatric surgery impacts favourably on the risk of congestive heart failure.”

People with a BMI>30 are considered obese. Bariatric surgery is generally recommended for people with a BMI>35. However, guidelines issued in January 2017 from the American Diabetes Association recommend bariatric surgery for Type 2 diabetes patients with a BMI>30 if their diabetes is poorly controlled.

In the 3,448-patient study, ‘Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long‐Term Risks of Congestive Heart Failure’, published in the Journal of the American Heart Association, half of patients received a gastric bypass and half did not. The surgery group saw their BMI drop from an average 46.5 to 32.5 after five years. BMI remained stable at around 46 in the non-surgery group.

The RYGB and matched controls (n=1724 in each cohort) were followed for up to 12 years after surgery (overall median of 6.3 years). Kaplan–Meier analysis revealed a statistically significant reduction in incident major composite cardiovascular events (P=0.017) and congestive heart failure (0.0077) for the RYGB cohort. Adjusted Cox regression models confirmed the reductions in severe composite cardiovascular events in the RYGB cohort (hazard ratio=0.58, 95% CI=0.42–0.82). Improvements of cardiovascular risk factors (eg, 10‐year cardiovascular risk score, total cholesterol, high‐density lipoprotein, systolic blood pressure, and diabetes mellitus) were observed within the RYGB cohort after surgery.

Eight years after the weight-loss surgery, 24 people had been diagnosed with heart failure, twice as many - 55 patients in the non-surgery group - developed heart failure. 

 “Most likely, reducing obesity and those secondary risk factors is what likely led to reduction in developing heart failure,” said Dr Philip Schauer, professor of surgery at the Cleveland Clinic Lerner College of Medicine and director of the Cleveland Clinic Bariatric and Metabolic Institute, who was not involved in the study.

Despite being the first published evidence of bariatric surgery’s ability to prevent heart failure, this study is not the first to show the connection. Preliminary results from the Swedish Obesity Study, found bariatric surgery cut the risk of heart failure by almost half after four years.

The authors concluded that these results support the growing body of evidence that metabolic surgery can improve health, including a substantial reduction in CVD risk factors and major cardiovascular outcomes.

To access this paper, please click here

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