S.o.s.

T he concept that type 2 diabetes mellitus (T2DM) can be reversed with an intestinal operation is coun-terintuitive. 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 " bari-atric 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 bari-atric surgery was associated with significant decreases in body weight, blood glucose, serum triglycerides, systolic and diastolic blood pressure, and an increase in HDL-cholesterol. Others have reported similar benefits of bariatric surgery on cardiovascular disease and mortality. Johnson et al. (2) mined the data in the South Carolina UB92 Inpatient Hospitalization Database and Death Records and concluded that in a cohort study of 349 bariatric surgical patients and 903 control subjects that " adjusting for age, comorbidities, and event history, the relative risk of mortality was reduced by 40 per cent in bariatric patients compared with controls. " Similarly , Batsis et al. (3), calculated the Framingham and the Prospective Cardio-vascular Munster cardiovascular risk scores in 197 patients who underwent the Roux-en-Y gastric bypass (RYGB) versus a matched cohort of 163 individuals who did not. With both scoring methods, car-diovascular relative risk was reduced from 79 to 18% with the Framingham instrument and from 62 to 8% to with the Prospective Cardiovascular Munster scores. In our study (4) of 232 severely obese diabetic patients of whom 154 underwent bariatric surgery versus 78 individuals who were also scheduled for but did not undergo the operations mainly because of …