The types of bariatric surgery included gastric bypass, in which stomach size is reduced with staples; banding, which uses an adjustable band to restrict food intake; and vertical banded gastroplasty, which also limits food intake.
During more than 14 years of follow-up, 28 people who had bariatric surgery died from a cardiovascular problem, compared with 49 who didn't have surgery, the researchers found.
There were 199 first-time heart attacks or strokes among the surgical patients, compared with 234 among the non-surgery participants, they noted.
Fewer fatal heart attacks occurred in the surgery group than the non-surgery group (22 versus 37). Surgery was also associated with fewer fatal and non-fatal strokes.
But no significant relationship was seen between weight loss and cardiovascular events in either group, the investigators found.
While that finding could be a statistical fluke, Sjostrom said other reasons could explain the finding.
"No non-surgical treatment has shown significant favorable effects on cardiovascular events in the obese," Sjostrom said.
"Our findings stress even more the favorable effects of bariatric surgery as compared to usual care. Also, all guidelines for bariatric surgery probably have to be modified since they all use BMI as the main criterion for patient selection," he said.
Dr. Edward Livingston, author of an accompanying journal editorial, agreed that weight should no longer be the determining factor for bariatric surgery.
Based on these findings, "the surgery should be targeted at treating a condition that will improve with weight loss," said Livingston, the Dr. Lee Hudson-Robert R. Penn Chair in Surgery chair of surgery at the University of Texas Southwestern Medical Center at Dallas. "There is something these patients benefit from f
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