First study to demonstrate long-term and sustained cardiac benefit for patients after gastric bypass

Total cholesterol, triglycerides and C-reactive protein levels are among 11 risk factors for heart attack that remained greatly reduced up to seven years after gastric bypass surgery, according to a new Stanford University study presented here at the 29th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS). Researchers say the study is the first to demonstrate a long-term and sustained cardiac benefit for patients after gastric bypass across so many risk factors.

"Patients significantly decreased their risk for having a heart attack within the first year of surgery and maintained that benefit over the long-term," said lead study author John Morton, MD, Associate Professor of Surgery and Director of Bariatric Surgery at Stanford Hospital & Clinics at Stanford University. Researchers also noted significant decreases in blood pressure and diabetes markers like fasting insulin and hemoglobin A1c.

Dr. Morton, a bariatric surgeon, and colleagues, studied 182 patients who had gastric bypass surgery and follow-up beyond three years at Stanford between 2003 and 2011. Patients were on average 44-years-old, and had an average body mass index (BMI) of 47.

Study investigators analyzed changes to 11 cardiac risk factors that have been shown to increase the likelihood of future heart attacks or coronary artery disease. These markers included lipid and cholesterol levels, metabolic syndrome, homocysteine (amino acid) levels, Framingham Risk Score and C-reactive protein levels, a measure of inflammation that Dr. Morton says may be the single most important predictor of future heart disease.

In up to seven years of follow-up, patients maintained a loss of about 56 percent of their excess weight, going from about 286 pounds, to about 205 pounds after surgery. Before surgery, nearly one-in-four patients were on statins, cholesterol lowering medications, which were discontinued shortly after surgery.

Patients saw a 40 percent increase in high-density lipoproteins ("good cholesterol"), a 66 percent drop in fasting insulin levels and sharp drops in triglycerides, which were reduced by 55 percent.

High sensitivity
C-reactive protein fell by 80 percent (10.9 to 2.6 mg/dL). The Framingham Risk Score, a composite predictive tool for future cardiac events, also decreased by nearly 40 percent.

"An 80 percent reduction in the C-reactive protein level is an astounding drop," said Dr. Morton. "This is significantly better than what the best medical therapy has been shown to achieve and underscores the inflammatory nature of obesity, which can be reversed with surgical weight loss."