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Bariatric Surgery May Help Prevent a Second Heart Attack in Obese Adults

Lap-Band placed on a replica stomach.
Tatyana Sokolova / Getty Images

Key Takeaways

  • Bariatric surgery can significantly reduce the weight of obese adults and lower their chance of having a heart attack, developing type 2 diabetes, and experiencing other negative health effects of obesity.
  • Not everyone who is obese is a candidate for bariatric surgery. Talk to your provider about the risks and benefits of the procedure.

A new study shows that bariatric surgery can be a preventative treatment approach for obese adults with a history of myocardial infarction (MI)—also known as a heart attack. The study found that having surgery decreased a person's risk of having a second MI. It also reduced the risk of having other cardiovascular health events that are associated with obesity.

To conduct the study, which was published in Circulation on October 26, researchers looked at the health records of obese patients in Sweden who had a history of a previous MI. Some of the patients underwent metabolic surgery and others did not. The researchers looked at their health outcomes over 8 years, with an average follow-up time of 4 years.

The results showed that patients who had bariatric surgery had a significantly lower risk of having another major adverse cardiovascular event, a second MI, and also a reduced risk of death during the follow-up period compared to the patients who did not have surgery.

The cumulative risk of a major adverse cardiovascular event over the 8-year follow-up was 18.7% for people who had surgery compared to 36.2% for people who did not have surgery. 

“Data shows that undergoing bariatric surgery increases a person’s life span,” Dan Azagury, MD, chief of minimally invasive and bariatric surgery at Stanford Health Care, tells Verywell. “The surgery also reduces the person’s chance of having a second heart attack by half.”

What Is Bariatric Surgery?

Bariatric surgery is an umbrella term that includes several surgical procedures that have durable weight loss as the ultimate goal.

The American Society for Metabolic and Bariatric Surgery (ASMBS) breaks these procedures into two categories: restrictive procedures (which decrease food intake and promote a feeling of fullness) and malabsorptive procedures (which reduce the absorption of calories, proteins, and other nutrients).

What Is Obesity?

According to ASMBS, obesity affects 34% of adults in the United States. Obesity can lead to negative health conditions, lower quality of life, disability, and even an increased chance of early death.   

Obesity is usually measured using the body mass index (BMI) scale. According to the ASMBS, the parameters of the scale are:

  • Normal BMI: 18.9 to 24.9
  • Overweight: 25 to 29.9
  • Class 1 Obesity: 30-34.9
  • Class 2 Obesity: 35-39.9
  • Class 3 Obesity: 40 and greater

The concept of weight loss surgery has been around since the 1950s when the jejunoileal bypass (JIB) surgery (which induced malabsorption by bypassing the intestines) was first performed at the University of Minnesota. The surgery had many complications, however, and is no longer a recommended weight loss surgery procedure.

The lessons learned from JIB led to the most popular types of weight loss surgery that are now offered to patients with lower risk and greater odds of success.

The most common bariatric surgeries include:

  • Gastric Bypass: Also called Roux-en-Y Gastric Bypass, this is the gold standard of weight loss surgery. The procedure divides the stomach and creates a small pouch that is attached to the small intestine. A person will need to eat smaller meals and therefore consumes fewer calories.
  • Laparoscopic Sleeve Gastrectomy: Also known as “the sleeve,” this procedure removes 80% of the stomach. This necessitates smaller meals and therefore intake of fewer calories. It also reduces the sensation of hunger and can lead to better blood sugar control.
  • Adjustable Gastric Band: Also called “the band,” this surgery uses an inflatable band to create a small stomach pouch that is tightened over time to reduce the amount of food that can be consumed and increases feelings of fullness. There is no malabsorption associated with this procedure.
  • Biliopancreatic Diversion with Duodenal Switch Gastric Bypass (BPD/DS): This procedure is similar to “the sleeve” procedure in that the small stomach pouch bypasses a segment of the small intestine (also called the duodenum) resulting in malabsorption of calories and nutrients, including protein and fat. It is considered the best surgical approach for the treatment of diabetes.

Who Can Get Bariatric Surgery?

Not everyone who is obese qualifies for bariatric surgery. It won't be considered a treatment option until other weight loss measures, such as diet and exercise, have proven ineffective.

ASMBS Criteria for Bariatric Surgery

The ASMBS states that someone who meets the following criteria would qualify for bariatric surgery:

  1. BMI ≥ 40, or more than 100 pounds overweight
  2. BMI ≥ 35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea or other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
  3. Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.

Benefits of Bariatric Surgery

The technological advances in bariatric surgery procedures over the last decade have allowed the benefits of the surgery to far outweigh the risks. 

“During the past decade, mortality has decreased,” says Azagury, who was not involved in the study. “Bariatric surgery, in terms of mortality, is now more comparable to getting your gallbladder removed or getting your hip replaced.”

Bariatric surgery causes significant weight loss. In turn, many underlying medical conditions, such as type 2 diabetes, cardiovascular disease, sleep apnea, hypertension, and stroke, usually improve.

Many people who have bariatric surgery also have type 2 diabetes. For 80% of these patients, Azargury says that type 2 diabetes resolves after surgery and the subsequent weight loss.

“There are very few other interventions that have such an effect on a person’s health,” Azagury says. “Whether they are at risk of a heart attack, or other health conditions, bariatric surgery will lead to a reduction in these issues.”

What This Means For You

Obesity can contribute to your risk of cardiovascular disease, type 2 diabetes, sleep apnea, hypertension, and other chronic health conditions. While not every person who is obese qualifies for bariatric surgery, for some, the surgery can be life-changing—if not life-saving.

If you have not been able to lose weight through diet, exercise, and other measures, you might want to talk to your healthcare provider about the types of bariatric surgery you meet the criteria for.

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  1. Naslund E, Stenberg E, Hofmann R, Ottosson J, Sundbom M, Marsk R, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with previous myocardial infarction and severe obesityCirculation. 048585.doi:10.1161/circulationaha.120.048585

  2. American Society for Metabolic and Bariatric Surgery (ASMBS). Story of Obesity Surgery. Updated Janaury 2004.

  3. American Society for Metabolic and Bariatric Surgery (ASMBS). Disease of Obesity.