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6/30/05 News Release

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WEIGHT-LOSS SURGERY PRODUCES UNEXPECTED DROP IN HEART DISEASE RISK,

STANFORD RESEARCHERS FIND

STANFORD, Calif. – A Stanford University School of Medicine study

using new measures of heart disease risk shows that gastric bypass

surgery reduces the risk of heart disease even more than previously

believed. The researchers say the finding underscores the value of

the surgery for extremely overweight people, whose obesity puts them

in danger of heart attack, stroke and other cardiovascular illness.

The researchers measured biochemical cardiovascular risk factors in

371 patients before surgery and again 12 months after gastric bypass

surgery, adding three new tests to the standard panel of cholesterol

and triglyceride assays. They saw improvements in all cardiac risk

factors, with the most significant improvements for triglycerides and

one of the new tests: C-reactive protein.

" Medication with statins — the most effective non-surgical treatment

available — lowers C-reactive protein by about 16 percent. But we

found that gastric bypass lowered it by 50 percent. That's a pretty

significant improvement over what's been considered state-of-the-art

therapy, " said senior author Morton, MD, assistant professor of

surgery at the Stanford School of Medicine and director of bariatric

surgery at Stanford Hospital.

Lead author , MD, a general surgery resident, will

present the study's findings at 7:45 a.m. Eastern time on June 30 at

the annual scientific meeting of the American Society for Bariatric

Surgery, held June 26-July 1 in Orlando, Fla.

Gastric bypass surgery, the most common form of weight-loss surgery,

reduces the stomach's size to limit the amount of food intake and

bypasses more than 35 inches of the approximately 20-foot-long small

intestine, which cuts down on nutrient absorption.

The number of gastric bypass surgeries has shot up in recent years,

increasing from 29,000 procedures in 1999 to about 141,000 in 2004,

according to the bariatric surgery society. The procedure poses about

a 2 percent risk of mortality and requires lifelong changes in eating

habits — but it's a life-saving operation for most morbidly obese

individuals, Morton said.

" This operation is reserved for morbidly obese people, not the

pleasantly plump, " Morton said. " Being morbidly obese carries a

pretty significant risk of premature death, in large part because of

heart disease. The risk of premature death for the morbidly obese is

about three times the risk of the general population. "

Though for most obese people, the most compelling reasons to lose

weight have to do with improvements in lifestyle, the health benefits

are tremendous, said. He expects that the new study will

encourage physicians to discuss the surgery with obese patients who

are at risk of heart disease. And he hopes that the findings will

push insurance companies that deny coverage for the procedure to

change their policies.

More than 15 million people in the United States are morbidly obese,

as measured by body mass index, which is a person's weight in

kilograms divided by height in meters squared. A BMI over 40

qualifies as morbidly obese, according to National Institutes of

Health guidelines for bariatric surgery. So, for example, a person

whose height is 5 feet 8 inches and weight is 265 pounds would have a

BMI of 40 and would be considered morbidly obese.

Morton, and Stanford colleagues knew from earlier studies by

others that gastric bypass lowered many risk factors for heart

disease but no large-scale studies had investigated the effects of

the surgery on all three newer heart-disease markers — C-reactive

protein, lipoprotein A and homocysteine, said. They set out

to study the effects and found improvements across the board.

" All of the values improved to where they were no longer in the

abnormal range. In other words, they normalized, " Morton said.

The most significant decrease in risk was seen in C-reactive protein

levels, which dropped from 10 mg/L to 3 mg/L. According to the

Centers for Disease Control, C-reactive protein levels greater than 3

mg/L indicate high risk for cardiovascular disease.

Interestingly, the improvements went beyond what would have been

expected due to weight loss alone. " We're not sure why, but the

process of bypassing the stomach might induce some changes in both

lipid and inflammatory metabolism, " Morton said.

The lowering of cardiac risk factors was especially compelling given

the patients' dire condition before their surgery,

said. " The study showed that these patients were at great risk of

heart disease before their surgery. Their risk factors were even

higher than we had expected, " he said.

" I think our findings show that this is not in any sense a cosmetic

procedure — that it really does benefit the health of these

patients, " added.

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