Weight-loss surgery reduced the risk by about 40% that diabetic patients would develop a range of heart complications, including the danger of an early death, a study found.
The drastic results are the latest report to detail the potential benefits of an operation that has been shown to help reverse diabetes, eliminate sleep apnea, improve fertility, ease joint pain and pressure, and relieve symptoms of depression. The new report, published in the Journal of the American Medical Association, suggests it may also help people live longer, healthier lives.
“When diabetes gets better, when risk factors like high cholesterol and blood pressure decrease, we would expect improvement," said Ali Aminian, the lead researcher and a bariatric surgeon at the Cleveland Clinic in Ohio. “But we didn’t expect it to this extent. That’s what’s surprising to us."
The findings come amid two critical trends in public health: a growing obesity epidemic and the slowing of progress made against heart disease, the leading cause of death worldwide. The two trends appear to be inextricably related, said Steve Nissen, head of cardiology at the Cleveland Clinic and the senior author of the paper.
“After 30 or 40 years of making steady progress in reducing cardiovascular disease rates, about five years ago that improvement slowed, then halted," Nissen said. “Now there is very good evidence that it’s now beginning to tick back up again. Virtually everyone believes that the obesity epidemic, and the diabetes that comes with it, is responsible."
The researchers tracked 2,287 diabetic patients who underwent weight-loss surgery at the Cleveland Clinic from 1998 through 2017. Their health was compared to a matched group of 11,435 people who didn’t undergo such an operation.
The study looked primarily at the risk of developing heart disease, stroke, heart failure, kidney damage, an erratic heart rate or death from any cause. After eight years, 31% of those who had surgery had experienced one of the serious complications, compared to 48% of those getting regular care.
Their chance of dying was also reduced by 41%, while the risk of heart failure and kidney damage both dropped by about 60%. Patients who underwent surgery lost more than 20% of their body weight and cut their reliance on medications like insulin to control their blood sugar and pills to reduce cholesterol and blood-pressure levels.
The researchers were uncertain if the swift and dramatic weight loss typically seen after surgery would significantly alter their patients’ long-term heart health, since any potential damage had been years in the making. While diabetic patients are particularly vulnerable to cardiovascular disease, few medications used to keep blood sugar in check have also been shown to improve heart health.
“I was uncertain about what would be found in such a study, but the effect size here is enormous," Nissen said. “It’s bigger than anything I’ve seen at reducing cardiovascular event rates."
Still, he said another study that assigned some patients to surgery and others to standard treatment, including blood-sugar control and weight-loss recommendations, is needed to confirm the benefits.
Only about 1% of Americans who currently qualify for weight loss surgery undergo it, Aminian said. There are strict criteria around who is eligible, impeding access, even as the operation is getting safer, he said.
The study itself has issues, including imbalances between patients who got surgery and those who didn’t, said Edward Livingston, deputy editor of JAMA and a surgery at the University of California, Los Angeles, in an editorial. Those getting surgery were heavier and had higher blood pressure and cholesterol levels, while those in the control group were older and more likely to have missing data, a potential sign that they were less careful about their health, he wrote.
“When balancing the imperfections in the evidence for both medical and surgical treatment of diabetes, the many benefits associated with bariatric surgery-induced weight loss suggest that it should be the preferred treatment option for carefully selected, motivated patients who are obese and have diabetes and couldn’t lose weight by other means," he said.
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