(HealthDay News) – Obese people who undergo weight loss surgery appear to reduce the risk of heart attack, cerebrovascular accident (CVA) and death, Swedish researchers report.
And these heart health benefits seem to be connected with metabolic changes that occur after surgery, such as impaired insulin production, rather than weight loss, researchers say.
"Bariatric surgery is associated with a reduction of about 30 percent in the incidence of both heart attack and stroke," said lead researcher Dr. Lars Sjostrom, professor at the Institute of Medicine of the University of Gothenburg.
"The body mass index before surgery does not predict the effect of surgical treatment, while insulin concentrations before surgery is associated strongly with the future benefit," he said.
Bariatric surgery involves altering the stomach to reduce the amount of food consumed or digested. Given these new findings, some experts believe that the criteria for operations to include more than the body mass index (BMI), a measure that takes into account height and weight.
"Before, we thought that surgery was a shortcut for patients who did not have the willpower to lose weight for themselves," said Dr. Francesco Rubino, chief of gastrointestinal metabolic surgery at Weill Cornell Medical College in the city of New York. However, surgery may save the lives of patients with diabetes or heart disease without control.
"I do not think a limit should disqualify BMI patients," said Rubino. It is considered obese when a person has a BMI of 30 or more.
The study, begun in 1987 and is published in the Jan. 4 issue of the Journal of the American Medical Association, is the first prospective study to show such cardiovascular benefits of weight loss surgery, the researchers said.
Sjostrom's team used the Swedish Obese Subjects study, and looked at data on more than 2,000 study participants who underwent bariatric surgery, and more than 2,000 who did not. All were in middle age, were white and obese, with and without pre-existing health conditions.
The types of bariatric surgery including gastric bypass were in reducing the size of the stomach stapling, gastric banding, which uses an adjustable band to restrict food intake, and vertical banded gastroplasty, which also limits food intake .
For over 14 years of follow up, 28 people who underwent bariatric surgery died from a cardiovascular problem, compared with 49 of those were not the surgery, the researchers found.
There were 199 first heart attacks or stroke among surgical patients, Does Phen375 Work compared with 234 among participants who did not undergo surgery, they noted.
There were fewer fatal heart attacks in the surgery group than in the nonsurgical group (22 vs 37). Surgery is also associated with fewer fatal and nonfatal stroke.
But there was no significant relationship between weight loss and cardiovascular events in either group, the researchers found.
Although this finding could be a statistical fluke, Sjostrom said other reasons could explain it.
"No non-surgical treatment has shown favorable effects on cardiovascular events among the obese," said Sjostrom.
"Our findings emphasize even more the favorable effects of bariatric surgery compared with usual care. In addition, all guidelines for bariatric surgery will probably have to be modified since they all use the BMI as the main selection criterion, "he said.
Dr. Edward Livingston, author of an accompanying journal editorial, agreed that the weight should no longer be the determining factor for bariatric surgery.
Based on these findings, "the goal of surgery should be to treat a condition would improve with weight loss," said Livingston, Professor Dr. Lee Hudson-Robert R. Penn Surgery Medical Center, University of Texas Southwestern in Dallas. "These patients benefit from some surgery that is not weight loss."
Obese patients with diabetes or sleep apnea could fit into this category as well as people with arthritis of the knee or hip joint replacement need, said Livingston.
He noted that the reason that improve these conditions is unclear. Perhaps the operation, better medical care, or take better care of patients, he suggested.
Depending on the operation itself, bariatric surgery costs between $ 10.000 and $ 20.000 more monitoring costs, and insurance coverage is not constant, Livingston said.
"Bariatric surgery addressed with caution. It is not a panacea. It has many disadvantages, "explained Livingston. Complications can include leaks, infection and embolism (a sudden blockage of an artery), he said.
In addition, many patients regain lost weight after surgery. "I really do not know what the very long term results of these operations," said Livingston.