HJAR Sep/Oct 2022

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2022 55 Samuel Bledsoe, MD, FACS, FASMBS Bariatric and Metabolic Institute Arkansas Heart Hospital In contrast, bariatric surgery has been shown in numerous trials to reduce both cardiovascular disease mortality rates and cardiovascular event rates. For instance, the Swedish Obese Subjects study was able to demonstrate a significant reduction in cardiovascular events and cardiovascular mortality. This reduction in cardiovascular disease mortality has been shown in mul- tiple other studies including a 2004 study in the Annals of Surgery , 2 a 2007 article from the NewEngland Journal ofMedicine , 3 and a 2021 article that appeared in Circulation. 4 With cardiovascular disease being the No. 1 killer in the United States and in Arkansas, we are in need of new tools and new think- ing to address this problem. Bariatric surgery results in significant improvements to the modifiable risk factors associated with car- diovascular disease, leading to measurable and significant improvements in cardiovas- cular mortality and cardiovascular events. While there is no single procedure or inter- vention appropriate for everyone, bariatric surgery must be considered for the obese population as a means of addressing underly- ing cardiovascular risk factors and ultimately death from cardiovascular disease. n REFERENCES 1 Ma, C.; Avenell, A.; Bolland, M.; et al. “Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis.” BMJ 359, is. 8130 (Nov. 14, 2017): j4849. 2 Christou, N.V.; Sampalis, J.S.; Liberman, M.; et al. “Surgery decreases long-term mortality, morbidi- ty, and health care use in morbidly obese patients.” Annals of Surgery 240, no. 3 (September 2004): 416-23. doi: 10.1097/01.sla.0000137343.63376.19 3 Adams, T.D.; Gress, R.E.; Smith, S.C.; et al “Long- term mortality after gastric bypass surgery.” New England Journal of Medicine 357, no. 8 (Aug. 23, 2007): 753-61. doi: 10.1056/NEJMoa066603 4 Doumouras, A.G.; Wong, J.A.; Paterson, J.M.; et al. “Bariatric Surgery and Cardiovascular Outcomes in Patients With Obesity and Cardiovascular Dis- ease:: A Population-Based Retrospective Cohort Study.” Circulation 143, no. 15 (April 13, 2021): 1468- 1480. doi: 10.1161/CIRCULATIONAHA.120.052386 Having grown up in Rogers,Arkansas, and having re- ceived amedical degree fromUAMS,Samuel Bledsoe, MD, returned to his roots to lead the Bariatric and Metabolic Institute at Arkansas Heart Hospital. He now also serves asmedical director ofArkansas Heart Hospital Encore Medical Center. Bledsoe completed residency at the Baptist Health System in Birmingham,Alabama,and completed ad- ditional training in Bariatric Surgery at the University of Alabama in Birmingham. In addition to other lead- ership positions, he previously served as the medi- cal director for Bariatric Surgery at Christus Cabrini Medical Center in Alexandria, Louisiana. Bledsoe is a Fellow of theAmerican Society for Meta- bolic and Bariatric Surgery and of the American Col- lege of Surgeons. in a near linear fashion as body mass index (BMI) increased. This sentiment was echoed in a manuscript published in 2009 in Lancet following 900,000 people while looking at BMI and mortality. They again showed this linear relationship of increasing mortality as BMI increased. Data revealed life expectancy decreased eight to 10 years in a person with a BMI of greater than 40, which is approxi- mately the same decreased life expectancy of smokers. Interestingly, while obesity has been shown to increase cardiovascular mortality rates, it is not clear that medical weight loss efforts will necessarily confer a cardiovascular risk reduction. For example, the LookAHEADTri- al followed obese type II diabetics for nearly a decade. During that time, the researchers failed to show a reduction in cardiovascular disease mortality despite intensive lifestyle modifications, and the trial was stopped for futility. A large meta-analysis in the British Medicine Journal also confirmed that medi- cal weight loss did not appear to confer car- diovascular protection. In their 2017 paper, researchers stated, “we were unable to show effects on cardiovascular and cancer mortal- ity, or participants developing cardiovascular events or new cancers.” 1 “Bariatric surgery results in significant improvements to the modifiable risk factors associated with cardiovascular disease, leading to measurable and significant improvements in cardiovascular mortality and cardiovascular events.”