MDNews - Cleveland-Akron-Canton

Improved Safety, Remarkable Benefi ts BA RIATRIC SURGERY IS not as risky as it used to be for patients living with extreme obesity and cardiovas- cular risk factors. "Bariatric surgery has had a profound improvement in quality control over the last 10 or 15 years," says Peter Benotti, MD, Senior Clinical Investigator at the Geisinger Obesity Institute. "The risks of the surgery are comparable to the risks of a gall bladder removal, and the benefi ts are astronomical in terms of the ability to control life-threatening diseases like diabetes, hypertension, cardiovascular disease and possibly even cancer." Other weight control therapies may have little to no effect for patients living with extreme obesity. A study conducted by Look AHEAD (Action for Health in Diabetes) found that a group of patients who underwent intensive lifestyle intervention saw almost no difference in cardio- vascular morbidity and mortality when compared to a control group. "Obesity is such an important risk factor [for cardiovascular disease]," says Philip Schauer, MD, Director of the Cleveland Clinic Bariatric and Metabolic Institute. "For those who have severe obesity, signifi cant weight loss with other treatment ... is very low." prior studies by looking at a long-term benefit from RYGB surgery in a broad patient population of those with and without Type 2 diabetes." DATA DEPTH Since 2004, Geisinger Health System has requested consent from its patients to collect EHR for research purposes. The patient consent rate at Geisinger is over 90 percent, which allows for the creation of large cohorts for studies. Almost 5,000 patients' EHRs were examined for the study. "A lot of our patients who receive bariatric surgery also receive care [in our healthcare system] for other reasons, specifi cally primary care," Hirsch says. " We were able to not on ly look at our ba riatric surger y patients but a lso look at a tightly matched control g roup so we could rea lly isolate the effect of surger y on cardiovascular outcomes a nd not worr y too much about confounding data ba sed on smoking habits or prior ca rdiova scu la r risks or things like that." The study, published in the Journal of the American Heart Association, found that patients who underwent RYGB surgery had a 45 percent reduced risk of a major cardiovascular event eight yea rs a f ter surger y. W hile hea r t attacks a nd strokes were lower a f ter metabolic surger y, those numbers were not statistica lly signif ica nt. Driving the ca rdiovascula r benef its was the decrease in the risk of congestive hea r t fa ilure. NEXT STEPS The fi ndings have piqued the interest of other researchers. "What was remarkable about the Geisinger Obesity Institute study was that patients had strong risk factors for developing heart failure over time," says Philip Schauer, MD, Director of the Cleveland Clinic Bariatric and Metabolic Institute. "However, the group that had bariatric surgery had a much lower rate of developing congestive heart failure than the control group." While the results of the study are promising, the precise reasons for the lowered risk of heart failure due to bariatric surgery are uncertain. "The study did not get into the mechanisms, but we do know that weight-loss surgery reduces cardiovascular risk factors like hypertension, hyperlipidemia and diabetes," Dr. Benotti says. "Weight-loss surgery seems to have the ability to reverse the eff ects of obesity on the heart." Though weight loss itself plays a large role in the health benefi ts of bariatric surgery, past studies — such as one published in Surgical Endoscopy and Other Interventional Techniques, the offi cial journal of the Society of American Gastrointestinal and Endoscopic Surgeons and European Association for Endoscopic Surgery — show positive eff ects on the body within weeks after a patient undergoes RYGB surgery. "It may not just be the weight loss," Hirsch says. "Changes in the body, such as a reduction in infl ammation, can occur almost immediately after metabolic surgery. We know there's an association between infl ammation and cardiovascular risk, so this reduction of infl ammation may be one of the protective eff ects of metabolic surgery." The Geisinger Obesity Institute plans to perform more research regarding bariatric surgery's benefi ts. " We're actua lly doing a follow-up study exa mining the mechanisms of individua ls before and after bariatric surgery with structural and heart imaging," says Christopher Still, DO, Director of the Geisinger Obesity Research Institute. "If we ca n fi g ure out the mecha nisms of the benefi ts of ba riatric surger y, hopefully we can correlate them with other thera- peutic interventions." n M D N E W S .C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ N O V E M B E R / D E C E M B E R 2 017 1 5

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