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Cardiorenal outcomes in eligible patients referred for bariatric surgery

Satya Dash1,2,3, Karl Everett4, Timothy Jackson3,5

  • 1Division of Endocrinology, University Health Network, Toronto, Ontario, Canada.

Obesity (Silver Spring, Md.)
|November 1, 2021
PubMed

Insights

Bariatric surgery significantly reduces cardiovascular disease (CVD) and heart failure hospitalizations, even in patients without type 2 diabetes (T2D). However, non-progression to surgery is linked to increased CVD risk, highlighting the need for further trials.

Area of Science:

  • Cardiology
  • Metabolic Surgery
  • Nephrology

Background:

  • Bariatric surgery is known to reduce cardiovascular disease (CVD) and heart failure hospitalizations in patients with type 2 diabetes (T2D) and pre-existing CVD.
  • However, most patients undergoing bariatric surgery do not have T2D or CVD, and their clinical outcomes are less established.
  • Many eligible patients opt out of surgery due to self-exclusion, despite potential benefits.

Purpose of the Study:

  • To assess the cardiorenal outcomes of bariatric surgery in a broad patient population, including those without T2D or prior CVD.
  • To investigate the association between non-progression to surgery and subsequent cardiovascular events.

Main Methods:

  • Retrospective analysis of cardiorenal outcomes in 8,568 patients referred for bariatric surgery.
  • Multivariate adjustment was used to control for various demographic and clinical factors.
  • Comparison of outcomes between patients who underwent surgery and those who did not.

Main Results:

  • Patients undergoing bariatric surgery showed significantly lower risks of primary (HR=0.52) and secondary (HR=0.53) CVD outcomes compared to those who did not.
  • These benefits were observed in both patients with (HR=0.45-0.47) and without (HR=0.53-0.61) T2D.
  • Surgery was associated with reduced kidney disease hospitalization (HR=0.46) but increased liver disease hospitalization (HR=2.5).

Conclusions:

  • Non-progression to bariatric surgery is associated with an increased risk of CVD, even in patients with a low baseline prevalence of CVD.
  • The cardiorenal benefits of bariatric surgery observed in this study warrant confirmation through a well-powered randomized clinical trial.
Abstract

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