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Fewer heart attacks seen after weight-loss surgery


NEW YORK (Reuters Health) – In a new study of obese Swedes, those who had weight-loss surgery were less likely to go on to suffer a heart attack or stroke, or die from one, compared to people who were managed without surgery.

The results jibe with an earlier report by the same group of researchers, suggesting that those participants who underwent bariatric surgery were less likely to be diagnosed with diabetes or die from any cause over the following decade.

But exactly how weight loss influences the risk of heart problems in obese people hasn't been completely clear, they note.

"This is very beneficial in filling that gap — we just have so little long-term data," said Ted Adams, who has studied bariatric surgery and health outcomes at the University of Utah School of Medicine in Salt Lake City.

Adams, who wasn't involved in the new research, said the findings will be helpful for informing doctors and patients about the long-term consequences of bariatric surgery and helping them assess the risks and benefits of the procedures.

The study doesn't prove that weight-loss surgery cuts the risk of heart disease, and one expert said there are still many questions about the long-term risks and benefits of the procedures.

The data come from a study of more than 4,000 obese people treated at 500 surgery departments and health care centers in Sweden. Between 1987 and 2001, half of those people and their doctors opted for weight-loss surgery, most often stomach stapling, and the other half were treated with routine care, including advice on lifestyle changes.

Researchers led by Dr. Lars Sjostrom at the University of Gothenburg followed those patients for the next 15 years, on average, to see how many of them suffered a heart attack or stroke.

In total, 199 people who'd undergone bariatric surgery had their first heart attack or stroke, and 28 died as a result. By comparison, 234 people who decided against surgery suffered a heart attack or stroke, and 49 died.

When the researchers took into account the initial health differences between people who did and didn't get surgery, the researchers found that after weight-loss surgery, patients were about 30 percent less likely to have a first-time heart attack or stroke than non-surgery patients, and half as likely to die from one.

They calculated that, based on their findings, about 50 obese people would have to get bariatric surgery to prevent one extra heart attack or stroke.

The surgery typically runs at about $20,000, but cost varies by the type of procedure.

Study participants who had weight-loss surgery started out with an average body mass index (BMI) of about 42 — equivalent to a five-foot, six-inch person weighing 260 pounds.

They lost an average of 16 percent of their starting body weight over the 15 years after the procedure, while the comparison group, which started out a bit lighter, didn't consistently lose or gain weight over time.

The researchers reported that 13 percent of the surgery group had complications after the operation. Complications can include blood clots and infections around the surgical site.

How much weight patients lost in either group wasn't tied to their chances of having a heart attack or stroke, Sjostrom and his colleagues wrote in the Journal of the American Medical Association.

One explanation for that, Adams said, is that the surgery has other health benefits that are independent of the amount of weight lost, such as a reduction in diabetes, which could ease heart risks. Those are all things to consider when very obese people decide whether or not surgery is the way to go, he added.

"My advice for patients — and physicians certainly help guide this process — would be to weigh the risks of the surgery, psychological and physiological risks and clinical risks, with their current health status," Adams told Reuters Health.

For example, an obese person with diabetes might be more apt to choose surgery than someone who's very heavy, but otherwise healthy, he said.

Dr. Edward Livingston, a contributing editor for the journal and a professor at the University of Texas Southwestern Medical Center in Dallas, said that the heart benefits seen here were small overall.

Given the uncertainty that still exists about the procedures — and the number of patients who just end up putting the weight back on — he thinks it's "wrong" to do bariatric surgery in heavy people without other health risks.

"We don't really know the full spectrum of long-term benefits and risks for these operations," Livingston, who wrote a commentary published with the study, told Reuters Health.

The choice to get bariatric surgery, Adams concluded, "should be a personal, very carefully analyzed decision."

SOURCE: Journal of the American Medical Association, online January 3, 2012.

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