Obesity and type 2 diabetes are associated with an increased incidence of macrovascular disease events, including coronary artery and cerebrovascular disease.1 The mainstay for treating type 2 diabetes is lifestyle modification for weight loss and pharmaceutical control of lipids, blood pressure, and glucose. These treatments have largely been shown to reduce microvascular disease, with less effect on development of macrovascular disease. It has always been known that bariatric surgery improves microvascular disease and in this issue of JAMA, Fisher et al2 report that bariatric surgery is associated with substantial improvements in macrovascular disease, begging the question: why is bariatric surgery not as well accepted as medications for treatment of type 2 diabetes?
Sheka AC, Wirth KM, Ikramuddin S. Preventing Macrovascular Events With Bariatric Surgery. JAMA. 2018;320(15):1545–1547. doi:10.1001/jama.2018.14639
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