Obese Patients With Coronary Artery Disease Can Consider Bariatric Surgery

The findings are important because coronary artery disease patientscan see a significant benefit with a successful procedure. Theresulting weight loss is also followed by an improvement in bloodpressure, cholesterol, blood sugar and sleep apnea, all factors linkedto coronary artery disease.

"In essence, obese patients with coronary artery disease might be thosewho need this surgery the most, but get it the least," says FranciscoLopez-Jimenez, M.D., Mayo Clinic cardiologist and lead author of thestudy.

The study is the first report about the safety and efficacy ofbariatric surgery in patients with a history of coronary arterydisease, the authors say.

"Roux-en-Y bariatric surgery appears to be an importantalternative in treating patients with coronary artery disease andobesity who cannot lose weight with standard approaches," says Dr.Lopez-Jimenez. "The surgery appears to be safe in properly evaluatedpatients with cardiovascular disease."

But Dr. Lopez-Jimenez says additional research is needed to determinethe effect of bariatric surgery on cardiovascular events among thesepatients. The analysis by the Mayo researchers included 52 patients whowere identified with coronary artery disease, who underwent bariatricsurgery at Mayo Clinic Rochester between March 1995 and January 2002.The effects on body weight and other cardiovascular risk factors wereanalyzed after surgery. After an average follow-up of 2.5 years withpatients, the researchers found significant decreases in weight loss,body mass index and blood pressure. Blood analysis showed decreases inkey indicators, as well.

MayoClinic.com notes that coronary artery disease is the most commontype of heart disease, affecting about 13 million Americans. The causeof coronary artery disease is atherosclerosis -- the gradual buildup ofplaque in the arteries that feed the heart. Each year, more than500,000 Americans die of complications of coronary artery disease.

The failure of conventional techniques to treat severe obesitysuccessfully sparked interest in surgical strategies. In 1991, theNational Institutes of Health Consensus Conference officiallyacknowledged the efficacy of bariatric surgery in producing short-termand long-term weight loss.

The use of these procedures has gained acceptance and is nowconsidered an option that physicians discuss with their obese patientswhen other weight loss options have failed.

However, Dr. Lopez-Jimenez said diet and increased physical activityshould remain as the initial approach in the treatment of obesity inpatients with coronary artery disease. Bariatric surgery should not beconsidered first for treatment of obese patients with coronary arterydisease because of its high cost and the potential risk of long-termcomplications in the digestive system.

Other physicians who contributed to this study include: MariaCollazo-Clavell, M.D.; Michael Sarr, M.D.; and Virend Somers, M.D.,Ph.D.; of Mayo Clinic. Sundeep Bhatia, M.D., was with Mayo Clinicduring the study, but now is with the University of SouthernCalifornia, Los Angeles.

A peer-review journal, Mayo Clinic Proceedings publishesoriginal articles and reviews dealing with clinical and laboratorymedicine, clinical research, basic science research and clinicalepidemiology. Mayo Clinic Proceedings is published monthly by MayoFoundation for Medical Education and Research as part of its commitmentto the medical education of physicians. The journal has been publishedfor more than 75 years and has a circulation of 130,000 nationally andinternationally. Copies of the articles are available online at www.mayoclinicproceedings.com.