AHA releases statement on bariatric surgery, CV risk factors

Issue: May 2011

In a first-of-its-kind scientific statement by the American Heart Association, the group acknowledges that bariatric surgery can significantly improve weight and obesity-related comorbidities, such as diabetes and cardiac complications, as well as prolong survival in severely obese individuals.

“Secondary to the demographic changes encountered in numerous countries and populations, obesity has become a burden on the health systems of industrialized countries and must now be regarded as a serious public health issue,” Paul Poirier, MD, PhD, and colleagues wrote in the statement, which was published in Circulation. “Strategies should now be developed for better long-term weight management of patients, and bariatric surgery is certainly a viable option today.”

The statement focuses solely on bariatric surgery and cardiac risk factors. Experts reviewed bariatric surgery indications, surgical options, surgery-related complications, and cardiovascular risk factor improvements and outcomes associated with each surgery option. The statement also includes information on postoperative management.

Although the statement is centered exclusively on bariatric surgery, it “is not an across-the-board endorsement of bariatric surgery for the severely obese,” Poirier, director of the prevention/rehabilitation program at Quebec Heart and Lung Institute at Laval University Hospital in Canada and lead author of the scientific statement, said in a press release. “It is a consensus document that provides expert perspective based on the results of recent scientific studies.”

Surgery options, complications

Purely restrictive procedures, including the adjustable gastric band and the sleeve gastrectomy, and hybrid procedures, such as the roux-en-Y gastric bypass and the biliopancreatic diversion, are outlined in the statement.

Poirier and colleagues also discuss the early and late complications of bariatric surgery. According to the statement, 30-day mortality rates associated with the operation range from 0.1% to 2%, with factors such as complexity of the operation, patient comorbidities, body habitus and surgeon or surgical center experience affecting these rates. Early complications may include thromboembolism (1%), pulmonary or respiratory insufficiency (1%), hemorrhage (1%), peritonitis (1%) and wound infection (2%), according to the statement. Late complications include gastrointestinal obstruction, marginal ulceration, incisional hernia, device-related complications and hypoglycemia.

Benefits, survival

The experts further discuss the effects of bariatric surgery on CV risk factors, including weight, diabetes, lipid profile and inflammation, nonalcoholic fatty liver disease, systemic hypertension, sleep apnea and cardiac function.

In addition, they cite studies that have demonstrated a significant survival benefit afforded by bariatric surgery.

“Eight studies (observational, case-control and/or nonrandomized) have demonstrated decreased mortality in patients who have undergone bariatric surgery compared with those who have not that is due specifically to decreases in myocardial infarction, diabetes and cancer-related deaths,” they wrote.

The researchers cite the 1991 NIH Consensus Conference statement on gastrointestinal surgery for severe obesity, which states that surgery is indicated for patients with a BMI of at least 40 or a BMI of at least 35 with high-risk comorbid conditions.

“These patients should have attempted prior conventional methods of diet and exercise, should be free of uncontrolled psychiatric disorders and should be medically sound enough that the benefits of surgery outweigh the risks,” Poirier and colleagues wrote.

Poirier P. Circulation. 2011;doi:10.1161/CIR.0b013e3182149099.

Disclosure: The researchers report no relevant financial disclosures.

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