Bariatric Surgery to Cut the Risk of a Heart Attack

The Torero of Broken HeartsCan bariatric surgery cut the risk of a heart attack in half? The answer, of course, depends upon the population of patients and their risk profile. And we must remember that risk is a tricky thing to measure. But a recent study in JAMA Network Open found half the risk of a wide range of cardiovascular events – including heart attacks – in patients with severe obesity and NAFLD who had bariatric surgery, compared to those who did not have the surgery.

The senior author on this study, Vinod Rustgi, points out that bariatric surgery is a more aggressive approach for managing these patients, but it can improve their lives in many ways:

“Although bariatric surgery is a more aggressive approach than lifestyle modifications, it may be associated with other benefits, such as improved quality of life and decreased long-term health care burden.”

Health Insurance Data

To reach this conclusion, Rustgi and colleagues analyzed health insurance records from 85,964 persons with severe obesity and NAFLD. Most of them (65 percent) received nonsurgical care. They balanced baseline covariates and applied inverse probability treatment weighting to account for potential confounding of risk factors among treatment groups. Nonetheless, the potential for unmeasured confounding remains. At the end of the day, this is still an observational study of the risk of heart attack and other events associated with bariatric surgery for these patients. Randomized clinical trials of bariatric surgery present nearly impossible challenges.

A Serious Challenge to Health

These data remind us that the combination of severe obesity and fatty liver disease presents a serious challenge to health. Cardiovascular disease is just one of the problems a person can expect. Diabetes is a common complication. Risk of cancer goes up, too.

However, these data tell us that the lasting effectiveness of bariatric surgery seems to cut these risks substantially. These same authors previously demonstrated a reduction in cancer risk for this patient population after bariatric surgery.

On top of all this, the options for treatment are expanding with the emergence of potentially more effective drugs for obesity in these patients.

So we have better tools than ever for care of patients in this population. But, noting that many do not get the best care available, we have to ask, why not? Why is it that most of these patients – whose lives might be better and longer with bariatric surgery – don’t receive it?

Click here for the new study by Rustgi et al and here for further perspective. For his study of cancer risk in these patients, click here.

The Torero of Broken Hearts, illustration by Gerda Wegener / WikiArt

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November 17, 2022

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