Jun 25, 2019
Obesity is the number one cause of cardiovascular disease in the U.S. However, new research shows that bariatric surgery can reduce heart attack and stroke risk in patients with obesity and diabetes by 40 percent within five years.
Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.
Host: We’re speaking with Dr. Timothy R. Shope, Chief of Bariatric Surgery at MedStar Washington Hospital Center. Thank you for joining us, Dr. Shope.
Dr. Shope: Thanks for allowing me the time to talk to you.
Host: Today we’re discussing 2018 research that suggests that bariatric surgery can dramatically lower the risk of strokes and heart attacks in obese patients who have diabetes. Dr. Shope, could you begin by discussing how obesity, diabetes, and the risk of heart attack and stroke are connected?
Dr. Shope: Sure. Many of our patients that we see coming to surgery for surgical weight loss purposes do have diabetes as a component of the multiple medical problems that they have. Obesity is becoming more and more common in our society. Diabetes is becoming more and more common in our society. They’re, without question, intertwined. And what we see is, particularly with this research that’s been done recently, patients that are diabetic and obese that have surgery, have a much lower risk of ultimately having a heart attack or stroke than diabetic, obese patients that do not have surgery or manage with medications alone.
Host: How can bariatric surgery reduce the risk of stroke and heart attack in a patient with diabetes?
Dr. Shope: Bariatric surgery not only helps patients lose weight - pretty simple thing. We put you on the scale - we can tell that you’ve lost weight. But a lot of these patients will have dramatic improvement in their medical problems as well. Specifically, in this case we’re talking about diabetes, patients that undergo particularly the gastric bypass surgery can have rapid improvement in their diabetic profile. We have some patients, not many, but a few a year will actually leave the hospital not taking their diabetic medications - simply checking their sugar and if it is a little bit too high, then they still have the ability to take some of these medications but they’re not taking them on a regular routine basis. The rest of the patients that do go home on their medications, within weeks and months they are dramatically reduced if not off of them. Similar results can be achieved with either the sleeve gastrectomy or the lap band, but usually it’s directly related to the amount of weight that these patients are losing. So with the sleeve gastrectomy, they do lose weight rapidly and often can get down on their dosages or converted from injectable medications to pills or come off all of the above within several months with the sleeve gastrectomy. With the lap band, which takes a little bit longer for patients to lose the weight, they can ultimately, in many cases, get down or off of their medications, particularly if they’ve been recently diagnosed with diabetes.
Host: After bariatric surgery, how likely is a patient to resolve or improve their diabetes?
Dr. Shope: Well, based on historical information, we know that, particularly, again, with the gastric bypass procedure, upwards of 85 to 90 percent of patients will resolve or substantially improve their use of diabetic medications and essentially not be diabetic any longer. A little bit less of a likelihood if they have a sleeve gastrectomy. And, with the lap band, it’s really only more like 50 to 60 percent of patients will ultimately be able to get off these medications. And again, if we’re talking about making the patient so that they are no longer diabetic from the standpoint of not needing medications and from the laboratory studies that we do to surveil these patients whether or not they’re diabetic - if we can claim that they’re no longer diabetic, the recent paper that we’re talking about today suggests that there’s around a 40 percent reduction in the risk of having a heart attack or stroke.
Host: Which patients would you consider ideal to have bariatric surgery, in part to improve their cardiovascular health?
Dr. Shope: Well, there are very strict NIH guidelines around these topics. The patients need to have a certain body mass index, or BMI. It’s basically a ratio of our weight to our height. So someone who’s very tall would also have to weigh a lot in order to meet the criteria for surgery. Likewise, someone very short might not have to weigh as much. But if you have a body mass index of greater than 40, or greater than 35 with certain medical problems like diabetes or obstructive sleep apnea or certain severe medical problems from other types of body systems, you might meet the criteria for weight loss surgery. Other ways of looking at this include things like being more than 100 pounds over your ideal body weight. These are some softer ways to look at whether or not someone might meet the criteria for surgery. So, if the patients otherwise meet the criteria for surgery, then all of the medical troubles that they come with, including those for cardiovascular risk, should improve with losing weight. There are some things that we can’t help patients with. For example, there are some downright skinny people that have high blood pressure. So, you may have high blood pressure for other reasons - family history, age, race, gender. These are things that obviously the surgery is not going to change about you. But if we can help you with your weight and that’s what’s maybe making you be hypertensive or making you be on three medications for high blood pressure, then we can hopefully reduce some of that. And again, most patients that are diabetic, with substantial weight loss, will at least improve, if not resolve, their diabetes.
Host: Could you share a story of a patient who had bariatric surgery and had a fairly dramatic cardiovascular outcome?
Dr. Shope: So, we’ve had many patients definitely improve their diabetic profile, and include their cardiovascular risk as well. It’s hard to prove that any one of our patients did not have a heart attack because of the weight loss and the improvement in their medical problems that they had just because of their surgery. The research that we’re looking at today talks about a population of patients. And, if you look at the population, we can see that there’s reduction in risk for these things. But for the individual patient, I’d love to be able to say that we prevented heart attacks - and we likely have - I just can’t point to a single individual that we know for certain we prevented. What I can tell you is that there have been a number of patients over the years that have dramatically reduced their reliance on diabetic medications and high blood pressure medications, so clearly improving their cardiovascular risk. We’ve had a couple of patients over the years that have even had prior heart attacks that come in for surgery, lose a whole bunch of weight, and their cardiologists are just so happy with the improvement in their cardiac function and their, again, reliance on these medications.
Host: Why should somebody with a history of diabetes come to MedStar Washington Hospital Center for bariatric surgery?
Dr. Shope: Well, I think bariatric surgery can be part of the treatment for these types of medical problems. In fact, potentially a cure in some patients. If we can get you off of your medications and your lab profile suggests that you’re no longer at risk for diabetes, I would consider that a cure and that’s quite a powerful statement to say that an operation can actually cure a medical problem. That’s not something that’s common at all. I think that, you know, we have experts in the field, we know how to do these operations, we know how to look after patients afterwards. And yes, of course, we’re going to include your diabetologist and your primary care doctor and be certain that the entire patient is taken care of here. But I think that we’ve got, you know, the right team in place at MedStar Washington Hospital Center to take care of this difficult problem.
Host: Thanks for joining us today, Dr. Shope.
Dr. Shope: Thank you.
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