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Bariatric surgery lowers co-morbidities out to ten years
Most patients with diabetes and obesity who undergo gastric bypass not only experience remission of their diabetes and lose significant weight, but they also reduce their risk of having a heart attack by 40 percent and their risk for suffering a stroke by 42 percent, over a 10-year time horizon. The outcomes were presented by researchers from Cleveland Clinic. The research was presented at the 30th Annual Meeting for the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2013, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The event was hosted by the ASMBS and The Obesity Society (TOS).
The study entitled, ‘Risk Prediction of Complications of Metabolic Syndrome Before and 6-Years After Gastric Bypass’, also showed that the five-year risk of death from cardiovascular disease dropped by 18 percent and the risk of developing moderate to severe kidney disease dropped by 45 percent. Patients were also at significantly less risk for intermittent claudication, pain caused by poor circulation, (four-year risk reduction of 47%) and other complications including diabetic retinopathy.
"This study emphasises that gastric bypass dramatically changes the trajectory of many chronic diseases associated with diabetes and improves multiple cardiovascular risk factors in the long term," said study co-author Dr Stacy A Brethauer, Staff Physician in the Section of Laparoscopic and Bariatric Surgery at Cleveland Clinic.
The study followed 131 patients with diabetes and obesity for a period of about six years after gastric bypass surgery. On average, patients lost 60 percent of their excess weight and had a diabetes remission rate of 61 percent. The average patient in the study had type 2 diabetes for more than six years before surgery.
Using multiple validated risk assessment models including the Framingham Risk Score, researchers were able to determine a patient's relative risk for coronary heart disease, stroke, myocardial infarction (heart attack), peripheral vascular disease (PVD), cardiovascular mortality and diabetic retinopathy. In all cases, surgery patients saw double digit decreases in the relative risk of developing these individual complications linked to diabetes.
The overall risk of developing coronary heart disease, stroke or peripheral vascular disease within the next 10 years dropped by 27 percent..
“Results of this study, which utilised different validated risk scores, indicate that bariatric surgery in diabetic patients, along with remarkable control of diabetes, dyslipidemia, and hypertension, is associated with a significant risk reduction for major complications including cardiovascular diseases (CHD, CVD, and PVD), nephropathy, retinopathy, and cardiovascular mortality in the range 18-47% at long-term,” the authors conclude. “The calculated risk estimates can be used to raise population awareness about the health benefits after bariatric surgery.”
The study, ‘Perioperative safety in the longitudinal assessment of bariatric surgery., was published in the New England Journal of Medicine (361 pp.445-454).
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