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Gastric surgery could halve heart attack and stroke rates

Obese people who have stomach surgery to help them lose weight could halve their risk of heart attack, according to a study published recently in the International Journal of Cardiology.1

Researchers from the University of East Anglia (UEA), University of Manchester and University of Aberdeen reviewed data from 14 studies involving more than 29,000 patients who underwent bariatric surgery. They found that, compared to non-surgical controls, there was a greater than 50% reduction in mortality amongst patients who underwent surgery. The study also showed that bariatric surgery is associated with a 50% reduction in risk of myocardial infarction, stroke and composite adverse cardiovascular event compared to obese people who did not have surgery.

The mean age of participants was 48 years old, and 30% of participants were male. The original studies were carried out the North America, Europe and Australia, and patients were followed-up from two years to 14 years.

This research is the first comprehensive review of the impact of surgery on heart disease, stroke and death, say the authors. Senior author Dr Yoon Loke (Norwich Medical School, University of East Anglia) said: “Obesity is a worldwide problem with significant consequences on individuals and society. It is associated with heart disease, type 2 diabetes, many cancers, and a shorter life expectancy.”

Dr Yoon Loke (Norwich Medical School, University of East Anglia)

Dr Yoon Loke (Norwich Medical School, University of East Anglia)

“The latest government figures from 2011 show that obesity affects about one in four people in the UK and this figure is growing. During 2011–12, the NHS reported 11,736 hospital admissions due to obesity, which represents an 11-fold increase compared to the 1,019 admissions in 2001–02.”

“We looked at the outcomes for patients who undergo bariatric surgery, and compared them to figures for obese people who had not received surgery. We saw that surgery was potentially life-saving and could lower the risk of having a heart attack and stroke by almost 50%.”

Speaking to BJC Arrhythmia Watch, Dr Loke said: “I am not aware of any randomised controlled trials underway in the NHS setting at the moment. Even within our systematic review, the observational data stems from countries such as Canada, Australia, the USA, Italy and Sweden.” He enquired: “Is this because bariatric surgery is not considered the highest priority in the NHS, perhaps due to a belief that obese people should do more for themselves through diet and exercise?”

“Equally, national figures indicate that less than 1% of morbidly obese patients are undergoing such surgery on the NHS. There are more than half a million morbidly obese people in the UK, and I seriously doubt that the NHS would have the capacity to offer surgery to more than a small proportion of these people,” he added.

“NICE have put fairly tight restrictions on eligibility for bariatric surgery, to maximise cost-effectiveness or value for money from the admittedly high cost of a surgical procedure (£5,000–10,000 per patient depending on complexity). This is the first systematic review to suggest benefits of bariatric surgery in reducing heart attacks and death. If these findings were confirmed in the NHS setting, then bariatric surgery may well prove to be better value for money than originally anticipated,” Dr Loke added.

“Physicians like myself regularly see obese patients who are at high risk of cardiovascular harm, and I think we should be offering surgical referral more frequently than we currently do,” he concluded.

References

1. Kwok CS, Pradhan A, Khan MA, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol 2014;173:20–8. http://dx.doi.org/10.1016/j.ijcard.2014.02.026

Published on: March 28, 2014

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