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Impact of bariatric surgery on cardiovascular outcomes and mortality: a population-based cohort study
P Singh1,2, A Subramanian3, N Adderley3
1Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Insights
Bariatric surgery significantly reduces mortality, hypertension, and heart failure risk. While overall cardiovascular disease risk was not significantly lowered, gastric bypass surgery showed a notable reduction in CVD incidence.
Area of Science:
- Medical research
- Surgical innovation
- Public health
Background:
- Bariatric surgery's impact on cardiovascular disease (CVD) and mortality requires further real-world data.
- Existing cohort studies suggest potential benefits, but robust evidence is limited.
Purpose of the Study:
- To investigate the effects of bariatric surgery on incident CVD, hypertension, atrial fibrillation, and all-cause mortality using real-world data.
- To compare outcomes between bariatric surgery patients and matched controls without surgery.
Main Methods:
- Retrospective, matched, controlled cohort study utilizing The Health Improvement Network (THIN) primary care database (1990-2018).
- Inclusion of adults with BMI ≥ 30 kg/m² without gastric cancer, matched with controls based on age, sex, BMI, and type 2 diabetes mellitus (T2DM) status.
- Analysis of 5170 exposed and 9995 control participants with a median follow-up of 3.9 years.
Main Results:
- Bariatric surgery was linked to a significant reduction in all-cause mortality (HR 0.70), hypertension (HR 0.41), and heart failure (HR 0.57).
- Overall CVD risk reduction was not statistically significant (HR 0.80), but gastric bypass surgery demonstrated a significant CVD risk reduction (HR 0.53).
- Outcomes were generally consistent across patients with and without T2DM, with a notable reduction in incident atrial fibrillation observed in the T2DM subgroup.
Conclusions:
- Bariatric surgery is associated with reduced risks of hypertension, heart failure, and mortality compared to standard care.
- Gastric bypass specifically demonstrated a reduced risk of cardiovascular disease compared to routine management.
Background:
Cohort studies have shown that bariatric surgery may reduce the incidence of and mortality from cardiovascular disease (CVD), but studies using real-world data are limited. This study examined the impact of bariatric surgery on incident CVD, hypertension and atrial fibrillation, and all-cause mortality.
Methods:
A retrospective, matched, controlled cohort study of The Health Improvement Network primary care database (from 1 January 1990 to 31 January 2018) was performed (approximately 6 per cent of the UK population). Adults with a BMI of 30 kg/m2 or above who did not have gastric cancer were included as the exposed group. Each exposed patient, who had undergone bariatric surgery, was matched for age, sex, BMI and presence of type 2 diabetes mellitus (T2DM) with two controls who had not had bariatric surgery.
Results:
A total of 5170 exposed and 9995 control participants were included; their mean(s.d.) age was 45·3(10·5) years and 21·5 per cent (3265 of 15 165 participants) had T2DM. Median follow-up was 3·9 (i.q.r. 1·8- 6·4) years. Mean(s.d.) percentage weight loss was 20·0(13·2) and 0·8(9·5) per cent in exposed and control groups respectively. Overall, bariatric surgery was not associated with a significantly lower CVD risk (adjusted hazard ratio (HR) 0·80; 95 per cent c.i. 0·62 to 1·02; P = 0·074). Only in the gastric bypass group was a significant impact on CVD observed (HR 0·53, 0·34 to 0·81; P = 0·003). Bariatric surgery was associated with significant reduction in all-cause mortality (adjusted HR 0·70, 0·55 to 0·89; P = 0·004), hypertension (adjusted HR 0·41, 0·34 to 0·50; P < 0·001) and heart failure (adjusted HR 0·57, 0·34 to 0·96; P = 0·033). Outcomes were similar in patients with and those without T2DM (exposed versus controls), except for incident atrial fibrillation, which was reduced in the T2DM group.
Conclusion:
Bariatric surgery is associated with a reduced risk of hypertension, heart failure and mortality, compared with routine care. Gastric bypass was associated with reduced risk of CVD compared to routine care.
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