Can Weight Loss Surgery Do My Heart Good?
Bariatric surgery provides substantial improvement in cardiovascular risks, which in turn provides impressive reduction in future cardiac events.
Cardiovascular disease (CVD) is the world’s leading cause of mortality, representing approximately 31% of all deaths, but CVD represents nearly 50% of all deaths in Mississippi.
Risk factors for CVD are age (males 45 years or females 55 years or older), gender (male), family history of CVD, hypertension, cholesterol abnormalities, smoking, diabetes, obesity and sedentary lifestyle. Obviously, some of these risk factors are non-modifiable. Modifiable risk factors include a sedentary lifestyle, tobacco use, unhealthful diet, obesity, hypertension, diabetes and cholesterol abnormalities.
Obesity is a well-established major risk factor of CVD, and waist circumference – especially when due to excess visceral fat – has been linked to many CVD risk factors including cholesterol abnormalities, insulin resistance, glucose intolerance, clotting abnormalities and blood vessel dysfunction. These factors are also linked to adverse CVD outcomes. Weight loss in such obese patients improves these CVD risk factors.
Traditionally, health care providers have focused on lifestyle interventions and medications to reduce CVD risk. Obese patients are commonly directed to increase physical activity. Studies show that performing moderate physical activity can achieve a 30% CVD risk reduction and reduce the incidence of premature death from CVD by about 50%.
However, patients with severe obesity often suffer from physical limitations caused by severe joint and back pain, which can ultimately lead to a sedentary lifestyle; thus, generating a vicious cycle of inactivity, low exercise capacity, further weight gain and ultimately, increased mortality risk.
Additionally, and unfortunately, nonsurgical weight loss trials have failed to demonstrate any benefit in terms of CVD events in obese individuals. However, a concept has emerged of using surgical alterations of the gastrointestinal tract to reduce CVD risk.
Bariatric surgery has been shown to reduce visceral fat with subsequent reduction in CVD risk factors. In a 12-year observational study of weight loss surgery patients compared to nonsurgical patients, investigators showed long-term durability of weight loss and effective reduction in rates of diabetes, hypertension and cholesterol abnormalities. Another review demonstrated a 40% relative risk reduction of CVD and striking remission rates in hypertension, diabetes and cholesterol abnormalities (68%, 75% and 71%, respectively).
Weight loss following bariatric surgery has also been associated with improvements in the heart and blood vessels themselves. Beneficial findings include improvement in heart function and heart chamber sizes.
After surgery, a significant reduction of plaque build-up in the arteries and a significant improvement in blood flow has been demonstrated. Obese patients having weight loss surgery experience a near 40% reduction in first occurrence of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, nephropathy and atrial fibrillation.
The Swedish Obese Subjects (SOS) study is one of the largest prospective, nonrandomized controlled studies looking at these cardiac outcomes. The surgery patients had 53% fewer CVD deaths; 33% fewer myocardial infarctions or strokes; and 29% fewer first time atrial fibrillation events.
In summary, bariatric surgery provides substantial improvement in cardiovascular risks, which in turn provides impressive reduction in future cardiac events – these are benefits that cannot be replicated with other weight reduction methods. Weight reduction surgery becomes an effective tool for preventive medicine physicians and cardiologists to improve their patient outcomes.