Prior bariatric surgery in a patient with morbid obesity is associated with a significant effect on survival after infarction or stroke.
While these are observational data, the significant metabolic improvement experienced after the surgery can explain perfectly such findings.
This large nationwide registry of bariatric surgery found a 40% decrease in the risk of death, infarction, or stroke for these patients compared with patients who did not undergo such surgery. This benefit is still observed after individuals are matched by body mass index (BMI). There already are many small studies showing similar data for obese patients who undergo bariatric surgery. Bariatric surgery has also proven to be an effective and durable treatment for type 2 diabetes, although the mechanisms for such effect are not entirely understood.
The US bariatric surgery database sponsored by the Agency for Healthcare Research and Quality assessed 995,577 patients hospitalized for acute myocardial infarction and 917,610 for stroke over an 8-year period. Of these, 2218 patients with infarction and 2,168 with stroke had undergone prior bariatric surgery. Those patients were compared with a control group of morbidly obese patients with the same risk characteristics using propensity score matching.
Death due to infarction was 1.85% in patients with prior bariatric surgery compared with 3.03% in morbidly obese patients (p = 0.004). Similar results were observed with stroke: 1.43% vs. 2.74% (p = 0.001).
An analysis using BMI to match patients showed nearly identical results.
Bariatric surgery should have never been seen as a cosmetic procedure, but rather a tool to treat metabolic disease.
Original Title: Bariatric Surgery is Associated with a Lower Rate of Death after Myocardial Infarction and Stroke: a Nationwide Study.
Reference: Aminian A et al. Diabetes Obes Metab. 2019 May 3. [Epub ahead of print].
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