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Metabolic surgery linked to better cardiovascular outcomes after heart attack

Reuters Health - 28/10/2020 - Patients who undergo bariatric surgery after myocardial infarction (MI) have better cardiovascular outcomes and lower mortality than their peers who don't have weight-loss surgery, a new study suggests.

Risk of major cardiovascular events (MACE), cumulative mortality and second MI were reduced by more than half in metabolic-surgery patients compared to controls, Dr. Eric Naeslund of Karolinska Institutet in Stockholm and colleagues found.

"Although the results are good and indicate that you are at an advantage if you undergo the surgery, they are not conclusive in the sense that you need to have a randomized controlled trial," Dr. Naeslund told Reuters Health by phone.

Metabolic surgery is an established treatment for type-2 diabetes, although its effects on CVD have not been as well studied, he and his colleagues note in Circulation.

To investigate, they used the SWEDEHART registry of heart-disease patients and the Scandinavian Obesity Surgery Registry to identify 566 patients who had bariatric surgery after MI. They were able to match 508 of these patients by sex, age, year of MI and BMI to 508 controls who had an MI but didn't have obesity surgery.

Patients were followed for a median of 4.6 years, with an interquartile range of 2.7 to 7.1 years. At eight years, 18.7% of the metabolic surgery group had had a MACE, compared to 36.2% of the non-surgery group (adjusted hazard ratio, 0.44; 95% confidence interval, 0.32 to 0.61).

Cumulative mortality was 11.7% with surgery and 21.4% without surgery (aHR, 0.45; 95% CI, 0.29 to 0.70), and cumulative MI incidence was 5.4% for the surgical patients and 17.9% for the controls (aHR, 0.24; 95% CI, 0.14 to 0.41).

Surgery patients' risk of new-onset heart failure was also lower, but there was no significant difference between the groups in stroke or new onset atrial fibrillation.

"I was surprised by the magnitude of the findings," Dr. Naeslund said. The results are likely to be applicable in other parts of the world, he added. "There might be regional differences, but I don't see why there should be any difference in outcomes."

He and his colleagues conclude, "Overall, our data indicate that metabolic surgery may be an important secondary prevention strategy in the growing population of severely obese individuals with established coronary artery disease."

By Anne Harding

SOURCE: https://bit.ly/31NfKwS Circulation, online October 26, 2020.

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