Bariatric Surgery Lowers the Risk of Major Cardiovascular Events

Andrew M. Brown, MD; Jie Yang, PhD; Xiaoyue Zhang, MS; Salvatore Docimo, DO; Aurora D. Pryo, MD, MBA; Konstantinos Spaniolas, MD

Disclosures

Annals of Surgery. 2022;276(5):e417-e424. 

In This Article

Abstract and Introduction

Abstract

Objective: This study examines the impact of bariatric surgery on the risk of myocardial infarction, stroke, and a composite of cardiovascular outcomes in a large population cohort. Additionally, the impact of different bariatric surgery procedures on cardiovascular outcomes is assessed and compared.

Summary Background Data: Bariatric surgery has been shown to improve comorbid conditions that are associated with cardiovascular disease and death. Few large studies have examined the impact of bariatric surgery on cardiovascular outcomes, and specifically compared the different bariatric procedures.

Methods: A retrospective, observational, matched-cohort study was conducted in adult patients with obesity in New York state from 2006 to 2012. Patients were stratified into 2 groups, based on utilization of bariatric surgery. Patients were further subgrouped based on the types of primary bariatric surgery. The primary endpoint was the development of specific cardiovascular events – myocardial infarction (MI), and stroke; as well as a composite of both events.

Results: A total of 328,807 patients, including 60,445 who had undergone bariatric surgery, and 268,362 matched nonsurgical controls were the study cohort for comparing surgical and nonsurgical patients. The risk of composite cardiovascular events decreased in the surgical group [hazards ratio (HR) = 0.48, 95% confidence intervals (CI): 0.45–0.51], as did the risk of MI (HR = 0.39, 95% CI: 0.35–0.42), and stroke (HR = 0.55, 95% CI: 0.51–0.59). Among the surgical cohort, sleeve gastrectomy patients had a higher risk of developing MI, stroke, and any type of cardiovascular event than gastric bypass patients.

Conclusions: Bariatric surgery is associated with decreased risk of significant cardiovascular events compared to nonsurgical controls. In this exploratory analysis, gastric bypass was associated with a lower risk of all cardiovascular events than sleeve gastrectomy.

Introduction

The impact of obesity on cardiovascular disease has been well documented.[1–4] In a large randomized clinical trial, overweight or obese individuals with Type II diabetes who underwent weight loss were followed for cardiovascular event (CE) outcomes. Individuals who lost at least 10% of their weight in the first year of the trial had a 21% lower risk of cardiovascular death, a nonfatal myocardial infarction (MI), a nonfatal stroke, or a hospital admission for angina.[5] This study brings to light that weight loss can positively impact cardiovascular outcomes.

Bariatric surgery has been shown to be efficacious in terms of weight loss and improvement in comorbid conditions, such as: hypertension, hyperlipidemia, diabetes mellitus, and obstructive sleep apnea.[6] And although these medical comorbidities are improved with bariatric surgery, there have been a limited number of large studies assessing the impact of bariatric surgery on specific cardiovascular outcomes. Based on the Swedish Obese Subjects (SOS) study, Sjöström et al compared bariatric surgery with usual care and found a cardiovascular death rate of 1.39% in the surgery group, compared to 2.41% in the control group (P = 0.002).[7] Benotti et al found that patients who underwent Roux-en-Y gastric bypass (RYGB) had a significant reduction in major composite CE as well as congestive heart failure compared to a matched cohort.[1] Furthermore, Aminian et al showed that patients with type 2 diabetes and obesity who underwent metabolic surgery had a lower incidence of MI, ischemic stroke, and mortality compared to a similar group that underwent nonsurgical management.[8]

Herein we examine the impact of bariatric surgery on the risk of MI, stroke, and a composite of cardiovascular outcomes in a large population cohort. Furthermore, we study the differences between the different bariatric surgical procedures, and their respective impacts on major CE.

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