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Original research article
Association between bariatric surgery and rate of hospitalisations for stable angina pectoris in obese adults
  1. Yuichi J Shimada1,
  2. Yusuke Tsugawa2,
  3. Hiroyasu Iso3,
  4. David FM Brown4,
  5. Kohei Hasegawa4
  1. 1 Department of Medicine, Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2 Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3 Department of Social Medicine, Public Health, Osaka University Graduate School of Medicine, Suita, Japan
  4. 4 Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Yuichi J Shimada, Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray/Bigelow 800, Boston, MA 02114 USA; yshimada{at}


Objective Obesity and stable angina pectoris (SAP) are important public health problems in the USA. However, little is known about whether weight reduction affects the rate of SAP-related morbidities. This study was designed to test the hypothesis that bariatric surgery is associated with a lower rate of hospitalisations for SAP in obese adults.

Methods We performed a self-controlled case series study of obese adults with SAP who underwent bariatric surgery using a population-based inpatient database in three states (California, Florida and Nebraska) from 2005 to 2011. The primary outcome was hospitalisation for SAP. We used conditional logistic regression to compare the rate of the outcome event during sequential 12-month periods, using presurgery months 13–24 as a reference period.

Results Our sample consisted of 953 patients with SAP who underwent bariatric surgery. The median age was 57 years, 51% were women, and 78% were non-Hispanic white. During the reference period, 25.3% (95%CI, 22.5% to 28.1%) had a hospitalisation for SAP. The rate remained stable in the subsequent 12-month presurgery period (adjusted OR (aOR) 0.84 (95% CI, 0.69 to 1.02); p=0.07). In the first 12-month period after bariatric surgery, we observed a significantly lower rate (9.1% (95% CI, 7.3% to 11.0%); aOR 0.33 (95% CI, 0.26 to 0.43); p<0.0001). Similarly, the rate remained significantly lower in the subsequent 13–24 months after bariatric surgery (8.7% (95% CI, 6.9% to 10.5%); aOR 0.31 (95% CI, 0.24 to 0.41); p<0.0001).

Conclusion In this population-based study of obese adults with SAP, we found that the rate of hospitalisations for SAP was lower by two-thirds after bariatric surgery.

  • hronic coronary disease
  • Coronary artery disease
  • Obesity heart disease

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  • Contributors Study concept and design: YJS, YT and KH.

    Acquisition of data: DFMB and KH.

    Analysis and interpretation of data: YJS, YT, HI, DFMB and KH.

    Drafting of the manuscript: YJS.

    Critical revision of the manuscript for important intellectual content: YJS, YT, HI, DFMB and KH.

    Statistical expertise: YJS and YT.

    Study supervision: KH.

  • Funding YJS was supported in part by an unrestricted grant from the American Heart Association National Clinical and Population Research Award and an unrestricted grant from Honjo International Scholarship Foundation. The researchers were independent from the funding organisations.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.