Weight loss surgery is proven to have significant cardiovascular benefits for patients with severe obesity and heart disease, but Irish patients still face six year waiting list.

A new study has found that patients with a history of heart disease who undergo bariatric or weight loss surgery are almost two times less likely to have a recurrent and fatal heart attack or develop heart failure compared to similar patients who did not have the surgery, showing that weight loss surgery is hugely beneficial for heart health in people with severe obesity.

The study* by researchers at the Cleveland Clinic in Florida in the US, was presented at the 36th American Society for Metabolic and Bariatric Surgery (ASMBS) Annual Meeting which took place in the US recently.

The research found that patients who did not have bariatric surgery were 1.87 times more likely to develop systolic heart failure, compared to those who had surgery.

The study also found that bariatric surgery had a protective effect against dying from recurrent heart attack, with the surgical patients having two and half times less risk compared to patients who never had the surgery.

A history of diabetes, which improves in most patients after weight loss surgery, considerably increased the probability of developing heart failure in those with a history of previous heart attack, according to the research.

The study compared the heart health outcomes of more than 8,000 patients who had weight loss surgery with more than 79,000 non- surgical patients with severe obesity and a history of heart disease using a large inpatient healthcare database in the US.

Nearly half of the patients who had surgery also had a history of some form of diabetes and 73.3 per cent had high blood pressure, while the nonsurgical patients had higher rates of both diseases, which are major risk factors for heart disease. Obesity is also a major risk factor for heart disease and fatal heart attacks. All patients had a body mass index (BMI) of 35 or higher.

Commenting on the research, study author Dr David Funes, research fellow at the Bariatric and Metabolic Institute at the Cleveland Clinic Weston, Florida. said, “Our findings suggest for the first time, that bariatric surgery can prevent the development of systolic heart failure and remarkably reduce death from recurrent myocardial infarction or heart attack in patients with a higher cardiovascular risk than the average population.”

Speaking to the Irish Heart Foundation Ms Helen Heneghan, Consultant Bariatric Surgeon at St Vincent’s University Hospital and St Columcille’s Hospital in Dublin, said that she has seen similar findings among patients in Ireland who had undergone obesity surgery in her service, although the numbers are smaller, and there is a need for longer follow-up. She said that patients with severe obesity and established heart disease or those who have suffered a heart attack previously and who have had bariatric surgery in her service, saw the same almost two-fold reduction in risk of a recurrent cardiac event.

“In Irish patients we also see the same decreases in blood pressure, cholesterol and blood glucose levels after bariatric surgery, in all the risk factors that cause heart disease. That ultimately lowers patients’ cardiovascular risk,” she said.

Ms Heneghan said that in addition to the known benefits in type 2 diabetes, bariatric surgery was also an excellent treatment for heart disease in people with severe obesity, both for primary prevention of cardiac events and secondary prevention in people with a history of heart disease.

“The other interesting thing to note is that this surgery is safe in people who have established heart disease, who have had a heart attack before or have risk factors for heart disease,” she added.

Ms Heneghan said that established heart disease was present in approximately 15 per cent of the patients who undergo bariatric surgery in Ireland, while over 60 per cent have high blood pressure and 60 to 70 per cent had high cholesterol; all of which as well as obesity, are major risk factors for cardiovascular disease.

Bariatric surgery can prevent heart disease establishing in the first place, and in people who have heart disease weight loss surgery can prevent further cardiac events or the disease getting worse, she said.

However, as previously reported by the Irish Heart Foundation, there is a complete lack of dedicated funding for bariatric surgery in Ireland, meaning that patients with severe obesity and heart disease here are not getting the benefit of this treatment.

In 2018, just 12 adult bariatric surgeries per million of the population were carried out in Ireland. Meanwhile other countries are carrying out between 400 and 600 such cases per million of the population per annum.

Ms Heneghan said there was currently up to a six year wait for surgery and there has been no dedicated programmatic funding for the service announced for next year.

She described the lack of funding as “really disappointing, because we can’t offer this excellent treatment to the people who really need it.”

Commenting Dr Angie Brown Medical Director of the Irish Heart Foundation said the research highlights the importance and benefits of effective treatment of the complex issue of severe obesity. “It’s an important study as it shows treatment with bariatric surgery reduces the risk of future cardiac events and improves individuals’ quality of life.”

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(*A102- Metabolic Surgery prevents Systolic Heart Failure and reduces mortality due to recurrent-myocardial infarction in patients with history of Coronary Artery Disease: a nationwide case-control analysis. David Romero Funes, Camila Ortiz Gomez, Juliana Henrique, Lisandro Montorfano, David Gutierrez Blanco, Emanuele Lo Menzo, Samuel Szomstein, Raul Rosenthal, Cleveland Clinic Florida)