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Effect of bariatric surgery on long-term cardiovascular outcomes: a nationwide nested cohort study
Osama Moussa1, Maddalena Ardissino2,3, Tobias Heaton2
1Division of Surgery and Cancer, Imperial College London, Praed Street, London, W2 1NY, UK.
Insights
Bariatric surgery significantly lowers the long-term risk of major cardiovascular events and heart failure in patients with obesity. This large study shows a reduced occurrence of myocardial infarction and mortality following the procedure.
Area of Science:
- Cardiovascular Medicine
- Bariatric Surgery Outcomes
- Obesity Management
Background:
- Obesity is a major risk factor for cardiovascular disease.
- Bariatric surgery is an effective weight-loss intervention for patients with obesity.
- Long-term cardiovascular effects of bariatric surgery require further investigation.
Purpose of the Study:
- To evaluate the long-term impact of bariatric surgery on cardiovascular outcomes.
- To compare cardiovascular event rates in patients who underwent bariatric surgery versus matched controls.
- To assess the risk of myocardial infarction, stroke, heart failure, and mortality post-bariatric surgery.
Main Methods:
- A nested cohort study using the Clinical Practice Research Datalink.
- Inclusion of 3701 patients who underwent bariatric surgery and 3701 matched controls.
- Primary endpoint: composite of fatal/non-fatal myocardial infarction and ischemic stroke; secondary endpoints: individual components, heart failure, and mortality.
Main Results:
- Bariatric surgery patients had significantly lower major adverse cardiovascular events (HR 0.410, P < 0.001).
- Reductions observed in myocardial infarction (HR 0.412, P < 0.001) and heart failure (HR 0.403, P = 0.026).
- No significant reduction in ischemic stroke (HR 0.536, P = 0.301); significant reduction in mortality (HR 0.254, P < 0.001).
Conclusions:
- Bariatric surgery is associated with a reduced long-term risk of major cardiovascular events in obese patients.
- The procedure demonstrates a significant benefit in preventing heart failure and reducing overall mortality.
- Findings support bariatric surgery as a strategy to mitigate cardiovascular risk in individuals with obesity.
Aims:
This study aims to evaluate the long-term effect of bariatric surgery on cardiovascular outcomes of patients with obesity.
Methods And Results:
A nested cohort study was carried out within the Clinical Practice Research Datalink. The study cohort included the 3701 patients on the database who had undergone bariatric surgery and 3701 age, gender, and body mass index-matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction and fatal or non-fatal ischaemic stroke. Secondary endpoints included fatal or non-fatal myocardial infarction alone, fatal or non-fatal ischaemic stroke alone, incident heart failure, and mortality. The median follow-up achieved was 11.2 years. Patients who had undergone bariatric surgery had a significantly lower occurrence of major adverse cardiovascular events [hazard ratio (HR) 0.410, 95% confidence interval (CI) 0.274-0.615; P < 0.001]. This was mainly driven by a reduction in myocardial infarction (HR 0.412, 95% CI 0.280-0.606; P < 0.001) and not in acute ischaemic stroke (HR 0.536, 95% CI 0.164-1.748; P = 0.301). A reduction was also observed in new diagnoses of heart failure (HR 0.403, 95% CI 0.181-0.897; P = 0.026) and mortality (HR 0.254, 95% CI 0.183-0.353; P < 0.001).
Conclusion:
The results of this large, nationwide cohort study support the association of bariatric surgery with lower long-term risk of major cardiovascular events and incident heart failure in patients with obesity.
