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

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.

“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).

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.

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.”