A Lighter Heart

New research proves that patients with heart disease will want to weigh the risks -- and the benefits -- of bariatric surgery.

For obese people who have tried the diet of the day, week or year without success, there is another option.

Weight-loss surgery, called bariatric surgery, reduces the size of the stomach, limiting how much a person can eat at one time. It redirects food to bypass most of the stomach and the first section of the small intestine. This limits the body's ability to absorb nutrients and calories. Within the first two years after surgery, most people lose 50 to 60 percent of their excess weight.

Until recently, bariatric surgery presented a Catch-22. It benefits people whose health is at risk because of obesity. Yet, for obese patients with heart disease, doctors worried the surgery itself posed high health risks.

Two new studies put the risks and benefits in perspective. "We found that bariatric surgery is safe for patients with heart disease," says Francisco Lopez-Jimenez, M.D., a Mayo Clinic cardiologist involved in both studies. "Patients who underwent bariatric surgery showed significant, long-lasting cardiac benefits when compared to people who followed traditional weight-loss programs."

In 2005, Mayo Clinic researchers published a first-of-its-kind study about the safety and efficacy of bariatric surgery in patients with a history of heart disease. Fifty-two patients were followed for about two years after surgery. Researchers found significant decreases in weight, blood pressure and cholesterol -- similar to improvements reported in patients without heart disease.

Researchers also found that bariatric surgery was relatively safe in patients with coronary disease, with a low rate of complications similar to that of other abdominal surgeries.

A second study compared the heart disease risk in 197 patients who underwent bariatric surgery to that of 163 obese patients in a traditional weight-reduction program. Results showed that the surgery patients had more significant improvements than the traditional group in blood pressure, diabetes indicators, cholesterol levels and body weight. Researchers estimated that the 10-year risk of death or heart event in the surgical group decreased from 37 percent to 18 percent. The risk for the traditional group remained the same at 30 percent.

In other words, over 10 years, bariatric surgery would prevent 16 cardiovascular events and four deaths for every 100 patients.

"Bariatric surgery is a viable option for obese patients with heart disease or at risk of heart disease," says Dr. Lopez-Jimenez. "But it's not an easy or quick fix. A healthy diet and increased physical activity remain the best and safest approach to reduce weight."