Weight-loss surgery might help prevent second heart attack

Severely obese persons (BMI >35) who suffer a heart attack and who then undergo weight-reduction surgery appear to have a lower risk of a second heart attack, major cardiovascular event, heart failure and death compared to medically similar persons who do not have weight-reduction surgery.

These findings appeared on Oct. 26, 2020, in Circulation.

“It is well known that obesity is associated with an increased risk for Type 2 diabetes and heart disease,” said lead author Erik Näslund, M.D., Ph.D., professor in the department of clinical sciences, Danderyd Hospital, Karolinska Institutet in Stockholm, Sweden. “It has also been shown that weight-reduction surgery can improve Type 2 diabetes and cardiovascular disease. What has yet to be proven is: if you have had a heart attack, can weight-reduction surgery reduce your risk of having another heart attack, which was the focus of our study.”

The investigators gathered data from two health registries, the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry and the nationwide Scandinavian Obesity Surgery Registry (SOReg).

They compared data gathered from 509 severely obese subjects who had suffered a heart attack to 509 severely obese patients who had also suffered a heart attack but then had either gastric bypass surgery or sleeve gastrectomy surgery.

Subjects who had undergone weight-reduction surgery were matched 1:1 to subjects with a similar BMI who had not had weight-reduction surgery. The average BMI of all subjects was 40. Other matching criteria included gender, age, health status and health history.

The investigators gathered follow-up data for up to eight years (median of 4.6 years.)

They found that the 8-year cumulative probability of major adverse cardiovascular events was lower in subjects who had undergone metabolic surgery (18.7% versus 36.2%). Subjects who had metabolic surgery also achieved a 45% lower risk of death and new onset heart failure.

The investigators found no significant differences regarding stroke or new onset atrial fibrillation.

The authors concluded, “In severely obese patients with previous MI, metabolic surgery is associated with a low risk for serious complications, lower risk of major adverse cardiovascular events, death, new MI, and new onset heart failure. These findings need to be confirmed in a randomized, controlled trial.”