S.O.S.

The concept that type 2 diabetes mellitus (T2DM) can be reversed with an intestinal operation is counterintuitive. How could our costliest disease be forced into full, durable, and safe remission with the bypass of a few inches of intestine? Counterintuitive or not, it’s true. Accordingly, we take notice when Sjöström and colleagues (1) in the Swedish Obese Subjects (SOS) study, the longest and most complete bariatric surgery outcome study in the world, document in this issue that bariatric surgery reduces the incidence of heart attacks. The SOS is a prospective, nonrandomized, controlled interventional trial on the effect of bariatric surgery on mortality and morbidity compared with conventional treatment that enrolled 4,047 obese individuals from 1 September 1987 to 31 January 2001. Of these, 2,010 underwent bariatric surgery, and a contemporary matched group of 2,037 did not. The current report compared the 345 diabetic patients who underwent bariatric surgery with the 262 who did not. The authors found that “bariatric surgery was associated with a reduced myocardial infarction incidence” (38/345 [11.0%] in the surgery vs. control group 43/262 [16.4%] [P = 0.017]). The effect was stronger in individuals with higher serum cholesterol and triglycerides at baseline. Not surprising, since the bariatric surgery was associated with significant decreases in body weight, blood glucose, serum triglycerides, systolic and diastolic blood pressure, and an increase in HDL-cholesterol