Obese people with diabetes had 40 percent fewer heart attacks and strokes – and 67 percent fewer deaths – within five years after bariatric surgery versus usual care, based on a large, long-term study in the United States.

The findings published in JAMA are significant given that some 30 million – more than 9 percent of adult Americans – have type 2 diabetes, according to the American Diabetes Association. Around 1 in 3 people with type 2 diabetes have a body mass index (BMI) of at least 35 kg/m2, and according to National Institutes of Health guidelines, the disease plus that degree of obesity makes them eligible for bariatric surgery. Bariatric surgery includes different operations that help people lose weight by making changes to their digestive system. 

The study was done at four systems in the Health Care Systems Research Network: Kaiser Permanente in Washington, Northern California and Southern California, and HealthPartners Institute in Minnesota. Participants included 5,054 Kaiser Permanente and 247 HealthPartners patients with diabetes and severe obesity (a body mass index, or BMI, of at least 35 kg/m2) who received bariatric surgery.

The study also included a matched control group of nearly 15,000 patients who had similar characteristics but received usual medical care for their weight and diabetes instead of bariatric surgery.

For many people with diabetes and severe obesity, lifestyle changes and medication may not be successful at lowering cardiovascular risks, explains internist and corresponding author David Arterburn, MD, MPH, a senior investigator at Kaiser Permanente Washington Health Research Institute. 

"So we're excited about our results, which suggest that bariatric surgery may reduce new cases of heart attack and stroke – and risk of death from all causes," Dr. Arterburn continues.

However the study is observational, not a randomised clinical trial, so it cannot definitively prove that bariatric surgery caused the decrease in the rates of heart attack, stroke, heart disease and death. 

"Our results add to the evidence that should inform conversations between people with diabetes and severe obesity and their health care providers about the potential benefits and risks of weight-loss surgery," Dr. Arterburn says. "We hope this helps them make more informed decisions about their care."

Previously, members of the same research team reported that people with diabetes who undergo bariatric surgery have half the risk of small-blood-vessel diseases of the feet, hands, kidneys and eyes within the first five years after surgery, compared to usual medical care for diabetes.

Source: Kaiser Permanente

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