Bariatric Surgery: Impact on Cardiovascular Events

By Dino Spaniolas, MD FACS FASMBS

Obesity is a known risk factor for heart disease. Some of the most influential epidemiologic studies in cardiovascular disease, like the Framingham study, have clearly shown that extra weight predisposes patients to higher risk of developing a stroke or heart attack in the future. What is even more alarming is that extra weight comes with additional conditions, such as elevated blood cholesterol and lipids, hypertension and diabetes. All these conditions further increase one’s chance of developing heart disease. So, a patient with extra weight, diabetes, hypertension and elevated cholesterol is at a much higher risk of experiencing strokes or heart attacks. We know from older research that significant weight loss can improve some of those risks.

 

Previous studies over the past decade have shown that bariatric surgery can lead to improvements in cardiovascular rates. Up to recently, it has been unclear if these results - mostly from northern Europe - would be similar for US patients, given the differences in obesity levels and lifestyle habits. Our team here at Stony Brook University, recently published in the Annals of Surgery the results of a large study on patients throughout New York State. We used anonymous data from the Department of Health and were able to track over several years more than 60,000 patients who had bariatric surgery in our state. The impact of surgery was impressive: we found that patients who had bariatric surgery were almost half as likely to develop a stroke or heart attack over a 10-year period. In essence, surgery decreased in half the rate of serious cardiovascular events.

These procedures involve very small incisions (laparoscopic or robotic), usually an overnight stay and a quick recovery at home. The chance of a major complication is less than 5%. The safety profile for bariatric surgery appears to be similar to gallbladder removal. When you put side by side the low risk of complications, with the significant long-term improvement in heart disease, the tremendous benefit of surgery is clear.. On that note, a recent long-term study from Sweden, published in the New England Journal of Medicine, one of the most prestigious medical journals, highlights the fact that patients who undergo bariatric surgery live on average 3 years longer.

Although this is a crude way of measuring weight and risk, most insurance companies use a measurement called body mass index to classify weight. For most insurance carriers, patients with body mass index greater than 35, with weight-related comorbidities, would be eligible for surgery. Several calculators online can allow anyone to find their body mass index, and it is always a good idea to check with your insurance carrier in order to verify bariatric coverage. Of course, we are always happy to see patients and go over their individual options, based on specific health history, needs and goals.