Can Weight Loss Surgery Prevent Heart Failure?

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Obesity is a risk factor for heart failure so losing weight early on can help prevent heart failure later. But what about surgical approaches to weight loss, like bariatric surgery (weight loss surgery) and surgically-placed weight-loss devices? Can those prevent heart failure too? Research sheds some light on this.

Obesity and Heart Disease

Obesity and overweight are conditions that are, unfortunately, risk factors for the development of several different kinds of cardiovascular disease including high blood pressure, heart attack, atrial fibrillation, stroke, and heart failure.

Obesity is also a well-recognized cause of type 2 diabetes, which is in and of itself a strong risk factor for cardiovascular disease. And obesity is a cause of high cholesterol, which is also a well-known cause of heart disease.

Additionally, obesity is a risk factor for the irregular heart rhythm known as atrial fibrillation, and people with atrial fibrillation are at risk for stroke. Obesity can thus affect many aspects of the cardiovascular system.

As noted above, there are many mechanisms by which obesity puts one at risk for these different cardiovascular conditions, but it is also important to remember that obesity increases inflammation throughout the body, and inflammation may also play a role in coronary heart disease.

Obesity and Heart Failure

First off, what is heart failure? Simply put, there are two main kinds of heart failure: systolic heart failure and diastolic heart failure.

In systolic heart failure, the heart fails to pump normally; this is associated with a reduced ejection fraction (a measure of pump function).

In diastolic heart failure (more recently known as heart failure with preserved ejection fraction), the ejection fraction is normal, but the heart is still not pumping normally due to the heart muscle being very stiff.

Both systolic and diastolic heart failure have a variety of causes, and even share some causes, such as high blood pressure, coronary artery disease, and obesity.

Either kind of heart failure can lead to the symptoms of what is known as congestive heart failure, in which fluid accumulates in the lungs, making it difficult to breathe; fluid can also accumulate in the legs, causing swelling and discomfort.

So, in heart failure, the heart is not able to pump normally or effectively to maintain adequate circulation throughout the body.

So what does obesity have to do with heart failure? In the guideline on heart failure released in 2013 by the American College of Cardiology Foundation and the American Heart Association, obesity is considered to be a starting point for heart failure.

This guideline lists obesity as a medical condition that would, by itself, place a person in Stage A of heart failure. Stage A, as defined by this national guideline, encompasses all those who are “at high risk for heart failure but without structural heart disease or symptoms of heart failure.” This means that, even though a person with obesity may not have any signs or symptoms of heart failure, they are still considered to be at the beginning stage of heart failure just by virtue of having obesity.

This makes a strong statement about the importance of treating obesity to avoid full-blown heart failure.

Bariatric Surgery Found to Prevent Heart Failure

Fortunately, weight-loss efforts do pay off, and if you have obesity you can make great strides toward preventing cardiovascular disease, including heart failure, by losing weight. Even a little bit of weight loss, in the range of five percent to ten percent of excess weight, can make a big difference.

And now studies have found that weight loss through surgery, including procedures like gastric bypass, sleeve gastrectomy, and lap banding, can also prevent cardiovascular disease like heart failure.

At the 2016 American Heart Association Scientific Sessions, researchers led by senior author Johan Sundstrom, MD, PhD, professor of epidemiology at Uppsala University in Sweden, presented the results of a very large study (of nearly 40,000 patients in total) which found that patients with obesity who had undergone bariatric surgery were much less likely to develop heart failure than those who did not undergo surgery but instead tried lifestyle changes like intense dieting and exercise.

The researchers postulate that the impressive effects of bariatric surgery may be due to bariatric surgery’s known effects on reducing risk factors for heart failure, such as diabetes, high blood pressure, and atrial fibrillation.

For instance, in a study conducted by Jamaly and colleagues and published in the Journal of the American College of Cardiology in December 2016, the authors found that, “compared with usual care, weight loss through bariatric surgery reduced the risk of atrial fibrillation among persons being treated for severe obesity.” Interestingly, this risk-reduction effect was most pronounced in younger people and in people with higher blood pressures.

It is also worth noting that bariatric surgery can result in much greater weight loss over the short term, as seen in Dr. Sundstrom’s study, in which, by one year after surgery, patients had lost an average of 41 pounds more than those who implemented only lifestyle changes (but no surgery).

In large part due to this sort of rapid weight loss over a relatively short term, bariatric surgery has been found in many studies to result in significant decreases in the rates of diabetes and high blood pressure, which in turn reduces overall risk for heart disease (since both diabetes and high blood pressure are risk factors for heart disease).

Are You a Candidate for Bariatric Surgery?

So, you may be wondering if you are a candidate for bariatric surgery. Keep in mind that there are several different kinds of surgical weight-loss procedures, but most of these procedures do have similar eligibility requirements.

According to the latest obesity guidelines released by the American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS), bariatric surgery may be an option for adult patients who meet certain criteria.

These criteria include a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater in a patient who has other medical conditions (known as “comorbid conditions”) caused by obesity. The obesity guideline writing committee did not find sufficient evidence to recommend bariatric surgery for patients who have BMIs that fall below these cutpoints.

The guideline further advises primary care doctors and others caring for patients with obesity with high BMI to try “behavioral treatment with or without pharmacotherapy” first, and then if this has not worked along with other diet and lifestyle measures to achieve sufficient weight loss, bariatric surgery may be considered.

So it is crucial to discuss this with your doctor, who can help you decide if you are indeed a good candidate for bariatric surgery and, if you are, which procedure would be right for you.

In What Other Ways Can You Reduce Your Risk for Heart Disease?

In addition to weight loss, there are several other important ways in which you can reduce your risk for heart disease in general and heart failure in particular.

First, know your numbers. This means getting your cholesterol checked, your blood pressure checked, and your blood sugar checked for pre-diabetes or diabetes. Taking charge of your health entails knowing where you’re starting from, so you can know which risk factors you have and deal with each one to reduce your overall risk.

As it turns out, many of the lifestyle changes that keep all these risk factors in check are similar, and they will help you maintain a healthy weight, too. Leading a heart-healthy lifestyle means getting daily exercise and following healthy eating habits.

One dietary style in particular has been shown, time and again, over decades of research, to prevent heart disease, and that is the Mediterranean diet.

Rather than being a fad diet that one chooses solely for the short-term purposes of weight loss, the Mediterranean diet is a lifestyle choice, a way of eating for the rest of one’s life. This is the natural style of eating for most of the inhabitants of countries surrounding the Mediterranean Sea—hence the name.

The Mediterranean diet emphasizes consumption of whole fruits and vegetables, whole grains, tree nuts, extra-virgin olive oil, fish and poultry, and wine (particularly red wine) in moderation.

As an added bonus, the Mediterranean diet has also been found to contribute to weight loss and to a lower risk of breast cancer.

Sources:

Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279-1290.

Jamaly S, Carlsson L, Peltonen M, Jacobson P, et al. Bariatric surgery and the risk of new-onset atrial fibrillation in Swedish obese subjects. J Am Coll Cardiol. 2016;68:2497-2504.

Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society [published online November 27, 2013]. J Am Coll Cardiol.

Sundstrom J, Bruze G, Ottosson J, Marcus C, et al. American Heart Association Scientific Sessions 2016. Abstract (poster session) presented live on November 14, 2016.

Yancy CW, Jessup M. Bozkurt B, Butler J, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013 Jun 5 [Epub ahead of print].

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