A study of a pair of large databases shows a strong link between obesity and heart failure.
Add heart failure to the list of ailments that obese patients can avoid through bariatric surgery, which allows obese patients to lose large amounts of weight that is less likely to return.1
A study presented Monday at the 2016 American Heart Association Scientific Sessions in New Orleans uses patient registries from Scandinavia to compare large groups of patients who had weight loss surgery with those who enrolled in intensive lifestyle modification regimens, which included very low-calorie diets.
After 4 years of follow-up the risk of heart failure was 50% lower among those who had surgery, compared with those who did not. Patients who had surgery had lower rates of atrial fibrillation, diabetes, and hypertension. Rates of death and heart attack were about the same.
Johan Sundstrom, MD, PhD, Uppsala Univ, Uppsala, Sweden, senior author, told The American Journal of Managed Care during the poster session that the study accomplishes a number of firsts. While the findings do not prove that obesity causes heart failure, it provides the strongest link yet between the 2 conditions, and one worthy of further study. Sundstrom said he will be doing more research on the connections between obesity and other cardiovascular ailments.
Sundstrom said this study also compared health outcomes for surgery patients with those who had lost significant amounts of weight through a lifestyle modification program. No patients had heart failure at the start of the study, and the group had an average body mass index of 30 kg/m2 or higher.
Both groups lost weight; After starting at an average of 119 kg (262 pounds) the lifestyle modification group lost 20 kg on average after the first year, while the surgery group lost about 38.8 kg after the first year. About 20% of the patients in the intense lifestyle modification group dropped out within the first year.
When asked if the study demonstrated the cost-effectiveness of treating obesity with bariatric surgery, he said the study was not designed to do that, but the data could be pulled out and evaulated. He pointed out that heart failure is the leading cause of hospitalization in the United States.2
Bariatric surgery was once viewed primarily as a means of helping severely obese patients lose weight; however, it has been shown to have medical benefits beyond weight loss. Many patients experience a reversal of type 2 diabetes (T2D). In May 2016, the journal Diabetes Care, the official journal of the American Diabetes Association, presented guidelines for when what it called “metabolic surgery” was appropriate for reversing T2D.
The registries were unusually large: researchers examined records from 25,804 patients who had bariatric surgery in Scandinavia, and 13,701 Swedish patients in a national registry who took part in a structured program that allowed only 500 calories a day for 3 to 10 weeks with a follow-up period of up to 8 weeks. In the interview, Sundstrom noted the patients were relatively young at an average of 41.5 years, before heart failure might start to appear. He said future studies might examine the effect of obesity surgery on preventing heart failure in older patients.
“Our study shows an association between obesity and heart failure and offers support for efforts to prevent and treat obesity aggressively, including the use of bariatric surgery,” Sundstrom said in a statement. “Bariatric surgery might affect the incidence of atrial fibrillation, diabetes, and hypertension—known as risk factors of heart failure—explaining the lower risk of heart failure we observed.”
1. Sundstrom J, Bruze G, Ottosson J, et al. Weight loss and heart failure. Presented at the 2016 American Heart Assoc
2. Desai AS, Stevenson LW. Rehospitalization for heart failure. Predict or prevent. Circulation. 2012; 126:501-506. http://dx.doi.org/10.1161/CIRCULATIONAHA.112.125435