Metabolic surgery cuts likelihood of recurrent and fatal heart attacks

November 05, 2019

LAS VEGAS - Nov. 5, 2019 - Metabolic surgery patients with a history of coronary artery disease were about two times less likely to have a recurrent and fatal heart attack or develop systolic heart failure compared to closely matched patients who did not have the surgery, according to a new study from Cleveland Clinic Florida researchers who presented their findings* today at the 36th American Society for Metabolic and Bariatric Surgery (ASMBS) Annual Meeting at ObesityWeek 2019.

Patients who did not have metabolic or bariatric surgery were 1.87 times more likely to develop systolic heart failure, compared to those who had surgery. The study also found that metabolic surgery had a protective effect against dying from recurrent myocardial infarction or heart attack, with the surgical patients having two and half times less risk compared to patients who never had metabolic or bariatric surgery. A history of diabetes, which improves in most patients after metabolic surgery, considerably increased the probability of developing systolic heart failure in those with a history of previous myocardial infarction.

The study compared the cardiovascular outcomes of about 8,200 metabolic surgery patients with more than 79,000 nonsurgical patients with severe obesity and a history of heart disease using the National Inpatient Sample (NIS), the largest all-payer inpatient healthcare database. Nearly half of the metabolic surgery patients also had a history of some form of diabetes and 73.3 percent had hypertension, while the nonsurgical patients had higher rates of both diseases, which are risk factors for heart disease. Obesity is also a major risk factor heart disease and fatal heart attacks. All patients had a body mass index (BMI) of 35 or higher.

"Our findings suggest for the first time, that bariatric surgery can prevent the development of systolic heart failure and remarkably reduce death from recurrent myocardial infarction or heart attack in patients with a higher cardiovascular risk than the average population," said study author David Funes, MD, research fellow at the Bariatric and Metabolic Institute at the Cleveland Clinic Weston, Florida.

Systolic heart failure occurs when the heart beats with too little force to push enough blood into circulation to meet the body's needs for blood and oxygen.[1] According to the U.S. Centers for Disease Control and Prevention (CDC), about 5.7 million adults have heart failure and about half of people who develop the condition die within five years of the diagnosis.[2] The American Heart Association estimates one in five people who have a heart attack will be readmitted to the hospital for a second one within five years. Each year, there are about 335,000 recurrent heart attacks in the United States.[3] Heart disease is the nation's No. 1 cause of death.[4]

"Metabolic surgery has been proven to have significant cardiovascular benefits and needs to be considered as part of the treatment plan for patients with severe obesity and coronary artery disease," said Eric J. DeMaria, MD, President, ASMBS and Professor and Chief, Division of General/Bariatric Surgery, Brody School of Medicine, East Carolina University Greenville, NC, who was not involved in the study. "The key is to treat obesity sooner rather than later to slow the progression of heart disease, reduce other risk factors including hypertension and diabetes, and preserve heart function."

The Centers for Disease Control and Prevention (CDC) reports 93.3 million or 39.8 percent of adults in the U.S. had obesity in 2015-2016.[5] The ASMBS estimates about 24 million have severe obesity, which for adults means a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40 or more. According to the ASMBS, 228,000 bariatric procedures were performed in the U.S. in 2017, which is about 1 percent of the population eligible for surgery based on BMI.

Metabolic/bariatric surgery has been shown to be the most effective and long-lasting treatment for severe obesity and many related conditions and results in significant weight loss.[6] The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques.[7] The risk of death is about 0.1 percent[8] and the overall likelihood of major complications is about 4 percent.[9] According to a study from the Cleveland Clinic's Bariatric and Metabolic Institute, laparoscopic bariatric surgery has complication and mortality rates comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy and knee replacement.[10]
-end-
About the ASMBS

The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit http://www.asmbs.org.

*A102

Metabolic Surgery prevents Systolic Heart Failure and reduces mortality due to recurrent-myocardial infarction in patients with history of Coronary Artery Disease: a nationwide case-control analysis David Romero Funes, Camila Ortiz Gomez, Juliana Henrique, Lisandro Montorfano, David Gutierrez Blanco, Emanuele Lo Menzo, Samuel Szomstein, Raul Rosenthal, Cleveland Clinic Florida

_______________________

[1] https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure

[2] https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

[3] https://www.heart.org/en/news/2019/04/04/proactive-steps-can-reduce-chances-of-second-heart-attack

[4] https://www.cdc.gov/heartdisease/facts.htm

[5] https://www.cdc.gov/obesity/data/adult.html

[6] Weiner, R. A., et al. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394. https://www.ncbi.nlm.nih.gov/pubmed/20361370

[7] Encinosa, W. E., et al. (2009). Recent improvements in bariatric surgery outcomes. Medical Care. 47(5) pp. 531-535. Accessed October 2013 from http://www.ncbi.nlm.nih.gov/pubmed/19318997

[8] Agency for Healthcare Research and Quality (AHRQ). (2007). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Accessed October 2013 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp

[9] Flum, D. R., et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed October 2013 from http://content.nejm.org/cgi/content/full/361/5/445

[10] Gastric Bypass is as Safe as Commonly Performed Surgeries. Health Essentials. Cleveland Clinic. Nov. 6, 2014. Accessed October 2017 https://health.clevelandclinic.org/2014/11/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/

American Society for Metabolic and Bariatric Surgery

Related Diabetes Articles from Brightsurf:

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Diabetes, but not diabetes drug, linked to poor pregnancy outcomes
New research indicates that pregnant women with pre-gestational diabetes who take metformin are at a higher risk for adverse pregnancy outcomes -- such as major birth defects and pregnancy loss -- than the general population, but their increased risk is not due to metformin but diabetes.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.