Bariatric Surgery and Heart Disease
Obesity is a major risk factor for heart disease. Bariatric surgery has emerged as a transformative option for individuals struggling with obesity, offering not only weight loss but also potential improvements in various comorbidities
Among these comorbidities, a critical area of concern is the relationship between bariatric surgery and heart disease. This blog aims to delve into the intricate connection between these two, exploring recent research findings and shedding light on the impact of bariatric procedures on heart health
What is Bariatric Surgery?
Bariatric surgery, also known as weight loss surgery, refers to a variety of procedures performed on the stomach and/or intestines to help people with severe obesity lose weight (1). Each approach differs in its mechanism of action, but all aim to achieve substantial weight loss. The most common types of bariatric surgery are:
- Gastric bypass - this surgery divides the stomach into a small upper pouch and a larger lower remnant pouch and re-routes the small intestine to connect to both (2). Food bypasses part of the stomach and small intestine, causing less absorption of calories.
- Sleeve gastrectomy - this surgery removes approximately 75% of the stomach, leaving a narrow tube-like stomach or "sleeve" (3). This smaller stomach cannot hold as much food, leading to eating less and feeling fuller sooner.
- Gastric banding - an inflatable band is placed around the upper portion of the stomach to create a small pouch. The band limits how much food can be consumed (4).
- Duodenal switch - this involves removing part of the stomach and re-routing the small intestine (5). Food bypasses more of the intestine, resulting in fewer calories absorbed.
Obesity and Heart Disease
Excess body weight places undue stress on the cardiovascular system, leading to inflammation, arterial stiffness, a higher risk of atherosclerosis, coronary heart disease, heart failure, and stroke (6). Adults with obesity are more likely to have conditions that increase heart disease risk like high blood pressure, high cholesterol, and type 2 diabetes (7). Excess body fat, especially around the abdomen, provokes systemic inflammation, insulin resistance, and metabolic abnormalities (8).
This can damage blood vessels and lead to the buildup of fatty plaques in arteries. Obesity stresses the heart by increasing how hard it must work to pump blood throughout the body. Over time, this can lead to enlargement and weakening of the heart muscle. Understanding this connection sets the stage for exploring how bariatric surgery may impact heart health.
Bariatric Surgery and Improved Cardiovascular Health
Recent studies indicate that bariatric surgery not only aids in weight reduction but also offers cardiovascular benefits. The American Heart Association (AHA) acknowledges the positive impact of significant weight loss on reducing the risk of heart disease, emphasizing the potential role of bariatric procedures.
- Weight loss- On average, patients lose 14-25% of their total body weight after bariatric surgery, greatly improving obesity (10). This takes pressure off the heart.
- Blood pressure- High blood pressure is present in 60-70% of bariatric surgery patients prior to surgery (11). After surgery, 76% of patients see resolution or improvement in hypertension (12)
- Cholesterol- Total cholesterol, LDL cholesterol, and triglyceride levels decrease markedly after surgery (13). HDL cholesterol increases.
- Insulin resistance- Bariatric surgery leads to improved insulin sensitivity and glycemic control, reducing diabetes risk (14).
- Systemic inflammation- Levels of inflammatory markers like CRP are reduced after bariatric procedures (15). This benefits the heart and blood vessels.
Multiple studies have shown bariatric surgery is associated with significantly lower rates of cardiovascular mortality, myocardial infarction, stroke, heart failure, and atrial fibrillation compared to matched control groups (16, 17). The benefits are most pronounced when bariatric surgery leads to substantial weight loss.
Mechanisms Behind Cardiovascular Improvement
Metabolic Changes Post-Surgery
Bariatric surgery induces profound metabolic changes, affecting insulin sensitivity, lipid profiles, and inflammation. These changes go beyond mere weight loss, influencing cardiovascular risk factors directly associated with heart disease.
Impact on Hypertension and Diabetes
Research suggests that bariatric surgery can lead to the resolution or improvement of hypertension and diabetes, both of which significantly contribute to cardiovascular complications. Understanding these changes provides valuable insights into the potential cardioprotective effects of bariatric interventions.
Considerations and Caveats
Individual Variability
While the overall trend indicates positive cardiovascular outcomes, it is essential to recognize that individual responses to bariatric surgery may vary. Factors such as pre-existing cardiovascular conditions, genetic predispositions, and lifestyle choices can influence the degree of benefit.
Long-Term Effects and Follow-Up
Long-term studies are crucial for assessing the enduring impact of bariatric surgery on heart health. Continued follow-up is necessary to monitor cardiovascular parameters and ensure that the initial benefits are sustained over time.
Conclusion: Bariatric Surgery and Heart Disease
In summary, the intricate interplay between bariatric surgery and heart disease is a multifaceted topic with promising implications. It can lead to considerable weight loss and reductions in risk factors for heart disease like hypertension, dyslipidemia, and diabetes. As research advances, a clearer picture emerges, showcasing not only the weight-reducing effects of bariatric procedures but also their potential to positively influence cardiovascular health.
While challenges and questions remain, the evolving landscape of bariatric surgery continues to offer hope for individuals seeking comprehensive solutions to obesity-related heart disease. For further reading and in-depth information, refer to reputable sources such as the American Heart Association, the World Health Organization, and recent studies published in peer-reviewed journals.
References:
- https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery
- https://asmbs.org/patients/bariatric-surgery-procedures/#gastric-bypass
- https://asmbs.org/patients/bariatric-surgery-procedures/#sleeve
- https://asmbs.org/patients/bariatric-surgery-procedures/#gastric-band
- https://asmbs.org/patients/bariatric-surgery-procedures/#biliopancreatic-diversion-with-duodenal-switch
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000000973
- https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/obesity-information-for-healthcare-providers
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648792/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406229/
- https://asmbs.org/resources/weight-loss-expectations-with-bariatric-surgery
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406229/
- https://care.diabetesjournals.org/content/34/Supplement_2/S279
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406229/#sec8title
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648792/
- https://www.hindawi.com/journals/jobe/2012/981461/
- https://www.nejm.org/doi/full/10.1056/nejmoa1600869
- https://jamanetwork.com/journals/jama/article-abstract/2679731
