Gastric Bypass Cuts Heart Attack Risk in Diabetes

The majority of patients with diabetes and obesity who undergo bariatric gastric bypass experience significant weight loss and diabetes remission. New research suggests these patients may also cut their risk of heart attack by 40% and their risk of stroke by 42%, over a 10-year time period. The findings were presented during ObesityWeek 2013 in Atlanta.

Researchers at the Cleveland Clinic followed 131 patients with diabetes and obesity for about 6 years after gastric bypass surgery. The average study participant had type 2 diabetes for more than 6 years before surgery. On average, patients lost 60% of their excess weight and had a diabetes remission rate of 61%.

“Surgical treatment of diabetes dramatically alters the trajectory of diabetes and, in many cases, results in diabetes remission,” says study co-author Stacy A. Brethauer, MD, staff physician in the Laparoscopic and Bariatric Surgery Section at Cleveland Clinic. “There are risks associated with surgery, but for the vast majority of our patients, the benefits of surgery far exceed the risks.”

Using multiple validated risk assessment models, Brethauer and his colleagues determined each patient’s relative risk for coronary heart disease, stroke, heart attack, peripheral vascular disease, cardiovascular mortality, and diabetic retinopathy.

In all cases, surgery patients saw double-digit decreases in the relative risk of developing these individual complications associated with diabetes. These included:

• An 18% reduction in 5-year risk of death from cardiovascular disease.
• A 45% decrease in the risk of developing moderate to severe kidney disease.
• A 4-year risk reduction of 47% for intermittent claudication (pain caused by poor circulation).
• A 27% drop in overall risk of developing coronary heart disease, stroke, or peripheral vascular disease within the next 10 years.

Developed by the American Heart Association, American College of Cardiology, and the Obesity Society, recently released guidelines for the treatment of obesity state that primary care physicians should refer patients who meet the criteria for bariatric gastric bypass for a surgical evaluation.

“We are hopeful that this clear recommendation will result in more patients gaining access to bariatric surgery,” Brethauer says. “Bariatric surgery is underutilized and is currently performed on only 1% of people who would qualify for it, so we need to do more to inform patients and referring physicians that bariatric surgery is safe and effective.”

He and his colleagues will continue to follow this cohort of diabetic patients and also proceed with their work on the STAMPEDE trial, a randomized study comparing the effectiveness of advanced medical therapy alone vs. bariatric surgery and therapy combined for the treatment of type 2 diabetes.

—Colleen Mullarkey

Reference

Brethauer S, Aminian A, Daigle C, Romero-Talamás H, Cetin DC, Kashyap SR, et al. Risk prediction of complications of metabolic syndrome before and 6 years after gastric bypass. Presented during ObesityWeek 2013 at 30th Annual Meeting for the American Society for Metabolic and Bariatric Surgery. 2013 Nov 11-16; Atlanta.


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