NEW YORK (Reuters Health) – Bariatric surgery and its associated weight loss significantly improve the cardiovascular risk profile of obese patients, according to findings published in the August 30th online American Journal of Cardiology.
“The bariatric community has recognized the remarkable metabolic benefits of weight loss surgery for several years, so we were not too surprised by the findings reported in this study,” Dr. Helen M. Heneghan from Cleveland Clinic, Cleveland, Ohio told Reuters Health in an email. “However, these findings may surprise cardiologists and physicians who treat obese patients for weight-related illnesses on a daily basis, yet are less familiar with the dramatic metabolic effects of bariatric surgery.”
Dr. Heneghan and colleagues reviewed 52 original studies involving 16,867 patients who had undergone bariatric procedures in an effort to determine the impact of bariatric surgery on cardiovascular risk factors and mortality.
In these studies, weight loss after bariatric surgery averaged 52% of excess weight. Excess weight loss was greater after Roux-en-Y gastric bypass (65%) and biliopancreatic diversion (69%) than after laparoscopic gastric banding (42%).
The Framingham risk score (reported in 3 studies) decreased significantly after bariatric surgery, from 6.3% preoperatively to 3.8% postoperatively, which represented a 40% relative risk reduction for 10-year coronary heart disease risk.
After bariatric surgery, patients experienced remission or resolution of hypertension in 68% of cases, diabetes in 75%, and dyslipidemia in 71%, with improvements seen as early as 3 months and persisting up to 155 months of follow-up.
Bariatric surgery and weight loss were also associated with reductions in systolic and diastolic blood pressure, improvements in the lipid profile, and decreases in fasting blood glucose and glycosylated hemoglobin.
In the only study that reported cardiovascular mortality, bariatric surgery was associated with a decrease in mortality secondary to myocardial infarctions of nearly twofold, from 1.2% to 0.65%.
“We hope that after reading this article, physicians will recognize that their obese patients with cardiovascular risk factors or established cardiovascular disease would benefit immensely from weight loss surgery,” Dr. Heneghan concluded.
“We would like to encourage all health care providers to seek more information on the benefits of bariatric surgery and would like to direct them to the bibliography of our article, which contains many important references in this field,” Dr. Heneghan added. “Furthermore, we hope that physicians will collaborate with their surgical colleagues in conducting prospective studies, further examining the cardiovascular and other metabolic effects of surgically-induced weight loss in the morbidly obese.”
Two of the 5 authors of this study report financial associations with companies that manufacture equipment used in bariatric surgery.
Reference:Effect of Bariatric Surgery on Cardiovascular Risk ProfileAm J Cardiol 30 August 2011.
