THE NEW THINKING ON PREVENTION AND TREATMENT OF HEART DISEASE, TYPE 2 DIABETES INCLUDES METABOLIC SURGERY



Published in September/October 2015 Issue             


The American Heart Association (AHA) and American Diabetes Association (ADA) have updated a joint scientific statement on cardiovascular disease in adults with type 2 diabetes, calling bariatric or metabolic surgery “the most effective treatment for attaining significant and durable weight loss in severely obese patients” with an ability to “reverse or improve may obesity-related conditions including type 2 diabetes.”

These were just a few of the findings in, “Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association,” published in the September editions of the journals, Diabetes Care and Circulation.

The new statement, which for the first time includes discussion and recommendations on bariatric and metabolic surgery, focuses on blood pressure and blood glucose control, cholesterol management, aspirin therapy, and weight management through lifestyle, pharmacological and surgical approaches.

The American Heart Association and American Diabetes Association first published a statement on heart disease and type 2 diabetes in 1999 and then later revised it in 2007. The 2015 statement takes into account subsequent clinical trials, studies and practice guidelines that, according to researchers, “have changed the clinical practice of cardiovascular disease risk management in diabetes mellitus.”


John Morton, MD

“This scientific statement from these two leading organizations reflects the new thinking and new evidence on how we can better prevent and treat cardiovascular disease and type 2 diabetes, and metabolic surgery is an important part of the equation,” said John M. Morton, MD, president of the American Society for Metabolic and Bariatric Surgery (ASMBS), who was not involved in the development of the AHA/ADA statement. “The data supporting metabolic surgery is strong and the need is great. We hope this statement leads to greater consideration by more patients and their doctors about this highly safe and effective, but often underutilized treatment option.”

The AHA/ADA statement references data that shows how bariatric surgery can result in weight loss, improvement in blood sugar control and reduction of cardiovascular risk factors. A meta-analysis involving 19 studies and 4,070 patients reported an overall type diabetes resolution rate of 78 percent after bariatric surgery. A review of another 12 studies comparing bariatric surgery with nonsurgical controls showed that bariatric surgery reduced cardiac events and all-cause mortality in all but two of the studies.


Philip Schauer, MD

“Although bariatric surgery causes weight loss and weight loss is good for diabetes, we now think of the operations as anti-diabetes procedures or metabolic surgery,” said Philip Schauer, MD, director of Advanced Laparoscopic & Bariatric Surgery for Cleveland Clinic’s Bariatric and Metabolic Institute and co-author of the AHA/ADA statement on surgery. “They improve diabetes by mechanisms other than just weight loss. It isn’t unusual to see patients who are on high doses of insulin prior to the surgery leave the hospital on no insulin at all and have relatively normal blood sugar.

Heart disease is the leading cause of death for both men and women in the U.S., according to the Centers for Disease Control and Prevention. It is responsible for one in every four deaths each year. The CDC also reports that more than 72 million Americans have obesity and 29.1 million people
have diabetes.

Studies have shown individuals with a body mass index (BMI) greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals, as well as an increased risk of developing more than 30 obesity-related diseases and conditions including Type 2 diabetes, heart disease and certain cancers. In 2013, the American Medical Association (AMA) declared obesity a disease.