Key points: A recent study showed a long-term, reduced risk of microvascular complications following bariatric surgery, an intervention used frequently to manage and prevent diabetes in obese individuals. Microvascular disease (MVD), also commonly referred to as small vessel disease occurs when the walls of the small arteries of the heart experience damage; it is more common in women and in people with diabetes and hypertension.
Complications from undiagnosed and untreated MVD can be serious and life threatening in some cases. Without appropriate intervention, MVD can cause retinopathy that may lead to blindness and diabetic ulcers, which, if left untreated can result in limb amputation. MVD is also associated with neuropathy and nephropathy frequently resulting in kidney damage or failure necessitating dialysis or kidney transplant.
Metabolic control, however, can slow the progression of MVD development and is usually targeted through pharmaceutical and lifestyle interventions as well as bariatric surgery.
A recent study titled “Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycemic status: a post-hoc analysis of participants from the Swedish Obese Subjects study”, published by Lena Carlsson, et al in Lancet Diabetes & Endocrinology in February 2017, demonstrated positive effects of bariatric surgery on reducing the progression of MVD.
This study examined over 4000 participants with history of bariatric surgery. The primary aim was to assess long-term microvascular complications which are frequently seen in individuals with diabetes and obesity.
Data generated from the Swedish Obese Subjects (SOS) was obtained at the 2, 10, and 15 year follow up visits. The authors found 374 cases of microvascular disease in the control group compared to 224 in the intervention group.
A reduced incidence of microvascular events was seen in participants in the intervention group; these subjects were classified as either having been diagnosed with diabetes, prediabetes, or having normal glycemic levels prior to surgery. The greatest risk reduction in microvascular complications after bariatric surgery was seen in the prediabetes group. These results suggest that managing and preventing the progression of prediabetes through bariatric surgery can have long-term positive outcomes, one of which is to reduce the risk of MVD and subsequent complications.
Why is this clinically relevant?
- Management of prediabetes through bariatric surgery may reduce the risk for microvascular complications
- Additional, more aggressive research into the prevention and management of pre-diabetes should be undertaken, as surgery is not a viable option for all patients
- Management of metabolic disease through reduction of glycemic levels may reduce development of heart disease, diabetes, and other chronic conditions associated microvascular complications