Doctor Amgad Mentias, MD, staff in clinical cardiology at the Heart Vascular and Thoracic Institute at the Cleveland Clinic and assistant professor at the Cleveland Clinic Lerner College of Medicine, talks about the benefits of bariatric surgery for adults.
Interview conducted by Ivanhoe Broadcast News in April 2022.
Could you give our viewers some details on your newly published study on the impact of bariatric surgery on the cardiovascular system?
DR MENTIAS: Yes. So, we identified patients who had a diagnosis of obesity and did not have history of heart failure and underwent bariatric surgery for weight loss. And then, we compared some important cardiovascular outcomes in follow up between those patients and similar patients who were tightly matched on their age, sex, and other medical conditions and degree of obesity, and looked at how these cardiovascular outcomes were different between both populations.
What was the age range of people in the study?
DR MENTIAS: The mean age was 62 years and about 47 percent of the study population were between 65 and 75 years old.
How did you gather the data?
DR MENTIAS: We obtained the data from the Medicare database, which includes medical data for Medicare beneficiaries in the U.S.
What measures did you look at specifically?
DR MENTIAS: We looked at the degree of obesity and patients age and medical conditions, and then, we also looked into the risk of death, new onset heart failure, heart attack and strokes.
What were your findings?
DR MENTIAS: We found that patients with obesity who underwent bariatric surgery had significantly lower risk of death and new onset heart failure and heart attack and stroke in follow up compared to patients with the same degree of obesity who were managed conservatively without surgery.
What ways did patients’ cardiovascular health improve?
DR MENTIAS: There was significant reduction, more than 50 percent in the risk of new onset heart failure, and more than 35 percent risk reduction in the risk of death and a heart attack. And in addition to that, patients who did develop heart failure in follow up, if they have history of bariatric surgery, there was a 50 percent risk reduction in the rate of heart failure admissions to the hospital. So, even admission burden itself was much lower in these patients.
What are the implications for the findings for patients and for their doctors?
DR MENTIAS: For patients, the implications are that if a patient was diagnosed with obesity, they should not delay the decision to seek help if they have been trying to lose weight and have not been very successful. This surgery is safe and very effective in losing weight, and it also reduces the risk of bad outcomes, cardiovascular outcomes and follow ups. So, patients should initiate this discussion and should ask for referral to centers that can offer this surgery for them.
How are these findings different than other recent studies on bariatric weight loss and the cardiovascular system? Is there anything new or anything that surprised the researchers?
DR MENTIAS: Yes. So, the outcomes of bariatric surgery in young and middle-aged patients were well studied before. In our study, what was new is that we also wanted to look at the outcomes in relatively older patients who were 65 to 75 years old. And as I mentioned, these were more than 46 to 47 percent of our study population. And we did subgroup analysis, and we found that the impressive risk reduction for all the cardiovascular outcomes was still evident in patients younger than 65 years old, and patients who are 65 to 75 years old. It was also evident in patients without history of diabetes mellitus. And so, this was the first study to study these outcomes in a nationwide cohort from the U.S., as well.
Was there anything that surprised you guys who were doing this study?
DR MENTIAS: The amount of risk reduction in these patients were impressive. As I mentioned, it was more than 30 percent for most of the outcomes. Also, that the risk reduction was early on in the follow up. Even after six months to 12 months after surgery, the difference in the risk between patients managed with bariatric surgery versus patients managed medically was very evident, so the amount of risk reduction also early on in follow up.
END OF INTERVIEW
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