Medical Edge Newspaper Column

"Stomach Stapling" Can Be Good For The Heart

April 2, 2006
DEAR MAYO CLINIC:
Is it safe for me to have bariatric surgery if I have coronary disease? -- Illinois

ANSWER:
Yes, weight-loss surgery, also called bariatric surgery, is a safe option for obese patients who have stable heart disease.

The procedure reduces the size of the stomach, limiting how much you can eat at one time. It also redirects the 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 percent to 60 percent of their excess weight.

The dramatic weight loss is followed by improvements in blood pressure, cholesterol, blood sugar and sleep apnea, all factors linked to coronary artery disease. A few months after surgery, many patients need less medication for treatment of diabetes, high blood pressure or high cholesterol.

In 2005, Mayo Clinic researchers published what is believed to be the first study about the safety and efficacy of bariatric surgery in patients with a history of coronary heart disease (see below). Fifty-two obese patients with coronary artery disease were followed for an average of 2.5 years after bariatric surgery. Researchers found significant decrease in weight, body mass index, blood pressure and cholesterol -- similar to improvements reported in patients without heart disease.

They 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.

Experts believe that obese patients with heart disease are rarely offered the procedure as an option when, in fact, obese patients with coronary artery disease might be those who need the surgery most.

Whether or not heart disease is present, bariatric surgery is the treatment of last resort for obese patients. A healthy diet and increased physical activity remain the best and safest approach to reducing weight.

-- Francisco Lopez-Jimenez, M.D., Cardiology, Mayo Clinic, Rochester, Minn.