Weight-loss surgery linked to lower death risk, heart complications

Weight-loss surgery performed on patients with Type 2 diabetes and obesity is associated with a lower risk of death and major adverse cardiovascular events than usual medical care, suggests a study.

According to the study published in the journal 'JAMA,' such patients also lost more weight, had better diabetes control, and used fewer medications for diabetes treatment and cardiovascular disease than those undergoing usual medical care.

The observational study looked at nearly 2,300 patients who underwent metabolic surgery and 11,500 matched patients with similar characteristics who received usual medical care.

Patients underwent one of four types of weight-loss surgery (also known as metabolic surgery): gastric bypass, sleeve gastrectomy, adjustable gastric banding, or duodenal switch.

The primary endpoint of the study was the occurrence of death or one of five major complications associated with obesity and diabetes: coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and kidney disease.

Over an eight-year period, patients undergoing metabolic surgery were 40 per cent less likely to experience one of these events than those receiving usual medical care. Patients in the surgical group were 41 per cent less likely to die from any cause.

"The striking results that we saw after metabolic surgery may be related to the patients' substantial and sustained weight loss," said Ali Aminian, a bariatric surgeon at Cleveland Clinic and lead author of the study.

"However, there is a growing body of evidence to suggest that there are beneficial metabolic and hormonal changes after these surgical procedures that are independent of weight loss," added Aminian.

Patients who had metabolic surgery had an average of 15 per cent greater weight loss and lower blood sugar levels.

"Cardiovascular complications from obesity and diabetes can be devastating. Now that we've seen these remarkable results, a well-designed randomised controlled trial is needed to definitively determine whether metabolic surgery can reduce the incidence of major heart problems in patients with Type 2 diabetes and obesity," said Steven Nissen, Chief Academic Officer of the Heart & Vascular Institute at Cleveland Clinic and the study's senior author.