Does weight loss surgery reduce the risk of heart disease in obese patients with diabetes?

This review looked at the effect of bariatric surgery (BS; weight loss surgery) on blood vessel damage for people with type 2 diabetes (T2D) and obesity. It found that people who had BS had fewer complications such as kidney disease or nerve damage.

T2D is a condition where the body cannot effectively control the amount of glucose (sugar) in the blood. Over time, high blood glucose can damage the lining of blood vessels. This causes inflammation, which can lead plaque to form and the arteries to narrow. Additionally, T2D is closely related to obesity, which causes high blood pressure. All of these conditions contribute to heart attack, stroke, or other forms of cardiovascular disease (CVD). CVD is also known as a macrovascular disease because it affects the large blood vessels.

CVD can be prevented by controlling blood glucose using diet, exercise, and medications. However, it can be difficult to completely eliminate CVD. For patients with both T2D and obesity, weight loss surgery is another treatment option. BS reduces the size of the stomach and/or alters how food progresses through the gut. This surgery is highly effective at treating obesity, and a substantial portion of people with T2D achieve remission after the surgery. However, there are few large studies on whether the surgery also reduces CVD for patients with T2D.

This review combined data from five studies of 49,211 patients with T2D and obesity. Four of the studies used records of past patients. A third of patients (14,434) underwent BS. The remaining patients underwent usual care for T2D, such as insulin or other medications. The patients were followed for 10.96 years on average.

Patients who underwent BS had a 50% lower risk of CVD in the following years. The risk of death was also reduced by 61% for patients who had surgery.

Roux-en-Y gastric bypass (RYGB) led to a 61% reduction in CVD, which was greater than other forms of BS. RYGB connects the top portion of the stomach directly to the small intestines. RYGB causes more weight loss than other forms of surgery, but it is also more likely to lead to nutrient deficiencies.

This study found that weight loss surgery reduced the risk of CVD and death for patients with T2D and obesity.

Patients and their doctors decided whether to use BS. There may be differences between those who had surgery and did not which were not accounted for by the researchers.

Talk to your doctor about all of your treatment options, including weight loss surgery.