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Published on: March 27, 2018
Bariatric surgery reduces long-term rates of cardiac events and need for coronary revascularization: a
Alex D Michaels1, J Hunter Mehaffey1, Robert B Hawkins1
1Department of Surgery, University of Virginia Health System, PO Box 800709, Charlottesville, VA, 22901, USA.
Insights
Bariatric surgery significantly reduces heart attack risk and the need for coronary revascularization in obese patients. This study suggests bariatric surgery can be a valuable tool for preventing heart disease in high-risk individuals.
Area of Science:
- Cardiology
- Bariatric Surgery
- Public Health
Background:
- Obesity and related conditions increase coronary artery disease (CAD) risk.
- Bariatric surgery promotes weight loss and improves CAD risk factors.
- Limited data exist on bariatric surgery's impact on CAD outcomes.
Purpose of the Study:
- To investigate the hypothesis that bariatric surgery decreases CAD risk.
- To evaluate the effect of bariatric surgery on coronary revascularization procedures.
Main Methods:
- Retrospective study of 3410 bariatric surgery patients and 45,750 controls (1985-2015).
- Propensity score matching (1:1) balanced groups on demographics and comorbidities.
- Univariate analyses compared outcomes between surgical and non-surgical groups.
Main Results:
- Matched cohort: 3242 patients per group with median follow-up >6 years.
- Surgery group showed significantly lower rates of myocardial infarction (1.8% vs. 10.0%).
- Reduced rates of coronary catheterization, percutaneous coronary intervention, and bypass grafting in the surgery group.
Conclusions:
- Bariatric surgery significantly lowers myocardial infarction incidence and coronary revascularization rates.
- Outcomes support increased use of bariatric surgery for heart disease prevention.
- Retrospective design may introduce selection bias; further research is warranted.
Background:
Obesity and obesity-related comorbidities are associated with increased risk of coronary artery disease (CAD). Bariatric surgery results in durable weight loss and improvement in numerous CAD risk factors, yet limited data exist on CAD-related outcomes. We hypothesized that bariatric surgery would lead to decreased risk of CAD and reduced rates of coronary revascularization procedures.
Methods:
All patients who underwent bariatric surgery at a single medical center from 1985 to 2015 were identified. A control population of morbidly obese patients who did not undergo bariatric surgery was identified using an institutional clinical data repository over the same study period, propensity score matched 1:1 on patient demographics and comorbidities including cardiac history. Univariate analyses were performed to compare outcomes in the surgery and non-surgery groups.
Results:
A total of 3410 bariatric surgery patients and 45,750 non-surgical patients were identified. After 1:1 propensity-score matching, a total of 3242 patients in each group were found to be well balanced in baseline characteristics and risk factors. With a median follow-up of greater than 6 years, the surgery group had significantly lower rates of myocardial infarction (1.8% vs. 10.0%; RR 0.18), coronary catheterization (1.9% vs. 8.8%; RR 0.22), percutaneous coronary intervention (0.4% vs. 7.8%; RR 0.05), and coronary artery bypass grafting (0.6% vs. 2.3%; RR 0.26). Similar benefits were observed for subgroups of patients with and without diabetes.
Conclusions:
Bariatric surgery was associated with a significant reduction in the incidence of myocardial infarction as well as lower rates of coronary revascularization in a propensity-matched cohort of morbidly obese patients. Though the retrospective nature of this study may have introduced a degree of selection bias, these outcomes support increased utilization of bariatric surgery for the prevention of heart disease.
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