Obesity surgery reduced the risk of a second MI

According to the authors of the cohort study, obesity surgery reduced the risk of a secondary heart attack or other major cardiovascular event (MACE) in patients with severe obesity.

In this study, 509 patients with previous myocardial infarction (MI) who underwent obesity surgery were compared to controls that matched the previous MI without surgery. With a median follow-up of 4.6 years, the surgery group was significantly less likely to have a second heart attack (HR 0.24, 95% CI 0.14-0.41), said Eric Nesland, MD, MD, Karolinska Institute. The lead researcher said in Stockholm.

Write to journal circulation, Näslund et al. Also had a low risk of MACE in the surgical group (HR 0.44, 95% CI 0.32-0.61), mortality from all causes (HR 0.45, 95% CI 0.29-0.70), and newly developed heart failure. I reported that. (Cumulative incidence 2% vs 5%, HR not calculated). However, there was no significant difference in the risk of stroke or newly developed atrial fibrillation.

“Despite the relatively established effects of metabolic surgery as primary prevention of CVD [cardiovascular disease], The available data on the use of metabolic surgery for secondary prevention of CVD is minimal, “the study authors write. When confirmed by randomized controlled trials, “Severely obese patients with previous myocardial infarction are suggested to undergo metabolic surgery. Secondary prophylaxis.”

According to Näslund’s group, doctors were reluctant to use weight loss surgery in patients after MI because of concerns that the risk of perioperative complications and long-term side effects would not outweigh the benefits. In addition, there is an obesity paradox, which suggests that patients with established CVD have a high body mass index (BMI) and a low risk of death, they said.

“This uncertainty, along with the fact that it is difficult to achieve sustained weight loss, reduces the focus on weight and obesity in post-MI care,” they said. “However, the association between BMI and outcome in CVD patients appears to be U-shaped, and is at increased risk in patients with severe obesity (BMI> 35).”

Näslund et al. Analyzed data on patients with severe obesity and previous MI at national medical registries, including the Scandinavian Obesity Surgery Registry. Of the 509 surgical patients, 465 underwent Ruwai gastric bypass surgery and 44 underwent sleeve gastrectomy. They matched patients who had not undergone surgery in terms of gender, age, year of MI, and BMI.

Overall, the study patients were in good agreement, the researchers said, but in the surgery group, left ventricular ejection after MI (7% vs. 12%) and previous heart failure (10% vs. 10%). The proportion of patients with reduced rates was low. 19%), atrial fibrillation (6% vs 10%), and chronic obstructive pulmonary disease (4% vs 7%).

The median baseline BMI for surgical patients was 40. Two years after surgery, median BMI was 28 and total weight loss was 29% of body weight. Patients were followed for up to 8 years. The main results were all MACE, including the second MI, stroke, and cause of death, as the database lacked information on specific causes of death. These results were also analyzed individually. Secondary results included newly developed atrial fibrillation and heart failure.

Postoperative complications occurred in 42 surgical patients (8.4%) and 19 complications were classified as severe (3.8%). These rates were similar to those reported for patients with severe obesity without prior myocardial infarction, the study authors said.

Researchers said weight loss was unlikely to be the only driver of reduced risk of cardiovascular events in surgical patients. The majority of these patients showed clinical remission of type 2 diabetes, hypertension, and dyslipidemia. “Therefore, the observed benefits of metabolic surgery over MACE suggest that it is caused not only by greater and more sustainable weight loss, but also by other cardiac metabolic effects of metabolic surgery,” they said. It was.

They said the limits of the study included a lack of information about socio-economic status that could have influenced the results. In addition, they said that the study could not distinguish between these procedures because most patients underwent Roux-en-Yostomy and very few had sleeve gastrectomy.

“In conclusion, this study found that in patients with severe obesity with previous MI, metabolic surgery had a lower risk of serious complications compared to no surgery, and MACE, death, new MI, and new onset. It suggests a low risk of heart failure, and these findings should be confirmed in a randomized controlled trial, “said Näslund et al.