Weight-Loss Surgery Drops Heart Disease, Death Risk for Diabetics

For people who are obese and have type 2 diabetes, weight-loss surgery leads to more than a slimmer figure.

It also reduces the risk of heart complications and premature death by about 40% compared to standard medical care, new research says.

The Cleveland Clinic researchers compared the impact of various types of weight-loss (bariatric) surgery to usual medical care for people with type 2 diabetes treated between 1998 and 2017. Specifically, they looked at a composite of six components, including death from any cause, heart failure, heart disease, stroke, kidney problems and an irregular heartbeat called atrial fibrillation.

“When we looked at the components individually, we saw a reduction in all of those six, including the death rate,” said study lead author Dr. Ali Aminian, a bariatric surgeon at the Cleveland Clinic.

Dr. Steven Nissen — chief academic officer of the Heart and Vascular Institute at Cleveland Clinic and senior author of the study — called the findings “striking.”

“As a cardiologist, these findings tell me that if we can find a way to get people to lose weight, we can save a lot of lives,” Nissen said.

Aminian added that primary care doctors, endocrinologists and cardiologists should regard weight-loss surgery as a tool. “Instead of adding more medications, have a conversation with a bariatric surgeon [about whether surgery would be an appropriate treatment option],” he said.

The observational study tracked the health of almost 2,300 people with type 2 diabetes who had one of four types of weight-loss surgery. These included gastric bypass, sleeve gastrectomy, adjustable gastric banding and duodenal switch surgery.

The researchers compared the surgical group to about 11,500 matched patients who were given standard medical care.

After an eight-year follow-up, people who had weight-loss surgery had:

41% lower odds of dying from any cause,
62% lower odds of heart failure,
31% lower odds of heart disease,
33% lower odds of stroke,
60% lower odds of diabetic kidney disease,
22% lower odds of atrial fibrillation.

Additionally, those who had surgery lost more weight and used fewer medications for diabetes and other conditions.

Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City, reviewed the findings.

“We know that bariatric surgery works when we treat obesity and diabetes. It’s a good tool for certain patients. But surgery is not a panacea,” he noted.

“It’s a surgical intervention that has complications. Sometimes people need additional surgery. There can be later complications like dumping syndrome [when food gets “dumped” directly from the stomach to the small intestine without being digested] and malnutrition. And, not everyone is a candidate,” he explained.

Zonszein said newer medications for type 2 diabetes might lead to better outcomes for the medical management group than were seen in this study.

He also noted that many patients in this study weren’t taking blood pressure or cholesterol-lowering medications. These are now typically prescribed for people with type 2 diabetes.

Aminian said insurance companies usually pay for weight-loss surgery for certain patients, such as those with a body mass index (BMI) over 40. BMI is a rough estimate of body fat based on height and weight. A BMI of 30 is considered obese. People with a BMI of 35 who have other conditions like diabetes or sleep apnea can usually get coverage for weight-loss surgery.

The study was scheduled to be presented Monday in Paris at the European Society of Cardiology Congress’ annual meeting, and simultaneously published in the Journal of the American Medical Association.

More information

Learn more about weight loss surgery from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.