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Published on: December 18, 2017
Long-term cerebrovascular outcomes after bariatric surgery: A nationwide cohort study
Osama Moussa1, Maddalena Ardissino2, Alice Tang2
1Department of Surgery and Cancer, Imperial College, Praed Street, London, W2 1NY, United Kingdom.
Insights
Bariatric surgery significantly lowers the long-term risk of major cerebrovascular events and all-cause mortality in obese patients. This procedure aids in preventing strokes and improving overall survival rates.
Area of Science:
- Cardiovascular Science
- Metabolic Disorders
- Surgical Innovation
Background:
- Obesity-related inflammation and metabolic dysfunction increase cerebrovascular disease risk.
- Bariatric surgery effectively reduces weight and improves metabolic health in obese individuals.
- The long-term impact of bariatric surgery on cerebrovascular health remains understudied.
Purpose of the Study:
- To investigate the long-term effects of bariatric surgery on major cerebrovascular events.
- To assess the association between bariatric surgery and cerebrovascular morbidity.
- To evaluate the impact on specific event types and overall mortality.
Main Methods:
- Retrospective cohort study utilizing Clinical Practice Research Datalink data.
- Comparison of 4212 bariatric surgery patients with 4212 matched controls.
- Analysis of major adverse cerebrovascular events, ischemic/hemorrhagic events, and all-cause mortality using adjusted Cox proportional hazards models.
Main Results:
- Bariatric surgery was linked to a significantly reduced rate of major adverse cerebrovascular events (HR 0.352).
- Lower rates of ischemic events, particularly transient ischemic attacks, were observed.
- No significant difference in hemorrhagic events or acute ischemic stroke; however, all-cause mortality was significantly lower (HR 0.352).
Conclusions:
- Bariatric surgery is associated with a reduced long-term risk of major adverse cerebrovascular events in patients with obesity.
- The findings suggest a protective effect of bariatric surgery against cerebrovascular morbidity.
- Further research may elucidate the mechanisms behind these observed benefits.
Background:
The proinflammatory state and metabolic changes associated with obesity contribute to cerebrovascular disease. Bariatric surgery can achieve a reliable reduction in body weight and improved metabolic profile in obese patients. However, its impact on cerebrovascular morbidity remains unexplored. This study investigates the effect of bariatric surgery on long-term risk of major cerebrovascular events.
Methods:
A retrospective cohort study was designed. Data was extracted from the Clinical Practice Research Datalink. 4212 bariatric surgery patients were compared to 4212 age, sex, and BMI-matched controls. The primary composite endpoint was occurrence of any major adverse cerebrovascular event. Secondary endpoints included composite endpoints of ischaemic events, haemorrhagic events, individual components of the primary endpoint alone and all-cause mortality. An adjusted Cox proportional hazards model was implemented to analyse time to event data.
Results:
Mean follow-up length was 11.4 years. The primary endpoint occurred in 73 patients. The bariatric surgery group had significantly lower adjusted major cerebrovascular event rates (HR 0.352, 95 %CI 0.195-0.637). Bariatric surgery was associated with lower rates of ischaemic events (HR 0.315, 95 %CI 0.156-0.635), particularly from transient ischaemic attacks (HR 0.364, 95 %CI 0.171-0.775). There was no difference in the rate of haemorrhagic events (HR 0.442, 95 %CI 0.147-1.330) or acute ischaemic stroke (HR 0.221, 95 %CI 0.046-1.054). In total 229 patients died during follow-up. Overall, all-cause mortality was significantly lower in the bariatric surgery group (HR 0.352, 95 %CI 0.195-0.637).
Conclusions:
This study identifies an association between bariatric surgery and lower long-term risk of major adverse cerebrovascular events in patients with obesity.
