Weight Loss Surgery Should Be Considered Life-Saving Procedure for Overweight and Obese Patients with Cardiovascular Risk Factors
October 18, 2012
In the largest-ever systematic review of weight loss surgery and its effects on the heart, Cleveland Clinic researchers have found that bariatric surgery significantly reduces several risk factors for cardiovascular disease and improves the structure and function of the heart.
Cleveland Clinic researchers, led by James Young, MD, Chair of Cleveland Clinic's Endocrinology and Metabolism Institute, examined 73 bariatric surgery and cardiovascular risk factor studies involving almost 20,000 patients who underwent weight loss surgery. The researchers found that, prior to their surgery, about 44 percent of the patients suffered from hypertension, 24 percent from diabetes and 44 percent from high cholesterol. Following surgery, 63 percent saw their hypertension improve, 73 percent saw improvement in their diabetes, and 65 percent had their cholesterol levels fall. The mean follow-up was 57.8 months after surgery. The findings were published in Heart.
“It’s clear that losing weight by any means, and specifically by a surgical procedure, drastically lowers several major risk factors for heart disease,” said Dr. Young. “While bariatric surgery is not without its own risks, it should be considered a life-saving surgery, particularly for obese patients with high cardiovascular risk. There is no pharmacological alternative to weight loss or diabetes that can produce comparable results in such a short amount of time.”
In an additional group of 713 patients who had bariatric surgery, there was a significant decline in the patients’ left ventricular mass, or thickness of the heart muscle, which is a risk factor for heart failure. Researchers also found that two measures of heart relaxation, or diastolic function, improved following surgery. The E/A ratio, a measure of the filling velocity of the heart, improved from 1.28 to 1.48 across 391 patients, and isovolumic relaxation time, which is the time between the closing of the aortic valve and opening of the mitral valve, and one of the most common diastolic abnormalities in obese people, improved from 84 to 72.9 milliseconds.
Further research is needed to explain exactly how weight loss surgery improves cardiovascular risk factors. For instance, Dr. Young and his colleagues found that the decline in left ventricular mass is not a result of the subjects’ lowered blood pressure, but they cannot definitively say what is causing the heart to remodel.
Obesity is one of the greatest current public health challenges with more than 2.6 million patients dying annually as a result of their weight, according to the World Health Organization. The condition is associated with several risk factors for heart disease, including hypertension, diabetes and high cholesterol, resulting in elevated rates of heart disease and heart failure among the overweight and obese.
“There are multiple mechanisms by which bariatric surgery can improve cardiac health,” said Amanda Vest, MBBS, MRCP, a co-author and Cardiovascular Medicine Fellow at Cleveland Clinic. “But more research needs to be done to determine exactly how the weight loss is improving cardiac function.
“Regardless, patients who are considering weight loss surgery should seriously think about their risk levels for future heart problems and discuss them with their physicians. Our findings should move bariatric surgery beyond the realm of cosmetic procedures and into the spectrum of cardiovascular prevention.”
About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S.News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. About 2,800 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. Cleveland Clinic Health System includes a main campus near downtown Cleveland, eight community hospitals and 18 Family Health Centers in Northeast Ohio, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and opening in 2013, Cleveland Clinic Abu Dhabi. In 2010, there were 4 million visits throughout Cleveland Clinic's health system and 167,000 hospital admissions. Patients came for treatment from every state and from more than 100 countries.