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Surgery and heart disease risk

Bariatric surgery reduces coronary heart disease risk by 40 percent

40 percent of bariatric patients had complete resolution of diabetes and 44 percent no longer had arterial hypertension

Patients with severe obesity who get weight-loss surgery cut their risk of developing coronary heart disease by about 40 percent, according to a new study from Cleveland Clinic Florida researchers who presented their findings at ObesityWeek 2018, hosted by the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

In the presentation, ‘Can Surgical Weight Loss Reduce the Risk of Developing Coronary Heart Disease?’ (Abstract no. 119), researchers analysed the data of 1,330 of their patients with a BMI>40 or more with no history of coronary heart disease who had either laparoscopic sleeve gastrectomy or gastric bypass between the years 2010 and 2016. Before surgery, all the patients had prehypertension, 60 percent had arterial hypertension, and 40 percent had type 2 diabetes. The Framingham Coronary Heart Disease Risk Score, which estimates the risk of developing the disease in ten years, was eight-times higher than the general population for the 225 patients in the study for whom the score could be calculated based upon known risk factors. The average age of the patients was 51-years-old and 67 percent were female.

One year after weight-loss or bariatric surgery, the chances of getting coronary heart disease within the next 10 years dropped by 40 percent after patients saw significant improvements in blood pressure and diabetes – more than 40 percent of patients had complete resolution of diabetes and 44 percent no longer had arterial hypertension. Patients also lost more than 25 percent of their total weight and had a nearly 70 percent drop in BMI.

Emanuele Lo Menzo

"Our study shows bariatric surgery has a significant and unparalleled effect on the known risk factors for coronary heart disease in patients after one year," said Dr Emanuele Lo Menzo, study co-author, associate professor of surgery and chair of research, Cleveland Clinic Florida in Weston. "No other treatment, in such a relatively short period of time, can result in such significant weight loss, improvements in high blood pressure and resolution of type 2 diabetes. The key, however, is for patients to continue to have a healthy diet and exercise well after surgery to maintain their heart benefits."

The 2013 American Heart Association, American College of Cardiology and The Obesity Society Guideline for theManagement of Overweight and Obesity in Adultsadvises patients with a BMI40 or higher or a BMI>35 or higher, who have two other cardiovascular risk factors such as diabetes or high blood pressure, that bariatric surgery may provide significant health benefits.

Obesity is associated with increased risk of developing more than 40 other diseases and health conditions including type 2 diabetes and coronary heart disease. According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death in the US, claiming the lives of about 630,000 Americans each year, and accounting for about one in every four deaths.

Eric DeMaria

"The risk of coronary heart disease in people with severe obesity is profound and the effect of bariatric surgery on that risk is equally profound," said Dr Eric J DeMaria, president-elect of ASMBS and professor and chief, Division of General/Bariatric Surgery, Brody School of Medicine at East Carolina University in Greenville, NC, who was not involved in the study. "This study provides further proof that treating obesity means treating heart disease and a whole host of other diseases."

The CDC reports 93.3 million or 39.8 percent of adults in the US had obesity in 2015-2016. The ASMBS estimates about 24 million have severe obesity, which for adults means a BMI>35 with an obesity-related condition like diabetes or a BMI of 40 or more. In 2017, 228,000 bariatric procedures were performed in the US, which is about 1 percent of the population eligible for surgery based on BMI.

Co-authors of this study included Drs David Gutierrez Blanco, David Romero Funes, Cristian Milla Matute, Rama Ganga, Samuel Szomstein and Raul Rosenthal.

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