AoS: Surgery after heart attack can reduce LDL levels, increase life expectancy

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For heart attack survivors, partial ileal bypass surgery or bypass of the distal small intestine plus a tailored diet instruction plan can lower LDL cholesterol levels and increase life expectancy, according to a study published in the May 24 edition of the Annals of Surgery.

Henry Buchwald, MD, PhD, of the University of Minnesota Medical School, and colleagues reported data of the 25-year POSCH (the Program on the Surgical Control of the Hyperlipidemias) trial that assessed whether or not low LDL levels showed a decline in coronary heart disease (CHD) and MI.

The POSCH trial commenced in 1975 and looked at 848 heart attack survival patients who were between the ages of 38 and 60.

During the trial, the patients were assigned to two groups: 417 received diet instruction only treatment, while 421 received both diet instruction and ileal or small intestine surgery.

According to the researchers, results showed that after a 25-year follow-up, patients who underwent surgery compared to the control group had an increased life expectancy of one-year.

After five years, trial results showed that patients in the surgery group with an ejection fraction of less than or equal to 50 percent had increased rates of survival.

After 25 years of follow-up, results showed that overall life expectancy increased by one year, while those patients with ejection fractions of 50 percent of less reached an increase of 1.7 years. These rates of relative probabilities were 0.61 for the surgery arm and 0.51 for the control arm.

Additionally, for the control arm and surgery arm results showed survival probabilities of 0.51 and 0.57, respectively.

"This study contributes to a long path of findings from the POSCH trial, that is, high levels of LDL cholesterol are detrimental to your health,” said Buchwald.

The trial also showed that lower LDL levels were linked to fewer heart attacks, deaths, peripheral artery disease and heart disease incidences, the authors wrote.

The trial was funded by the National Institutes of Health (NIH), the University of Minnesota and the state of Minnesota.