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Comparative Effectiveness of Bariatric Metabolic Surgery Versus Glucagon-Like Peptide-1 Receptor Agonists on

Leena Saeed1, Gul Sharif2, Sanjay Eda3

  • 1Medical Research Center, Hamad Medical Corporation, Doha, QAT.

Cureus
|November 18, 2024
PubMed

Insights

Bariatric metabolic surgery (BMS) significantly reduces major adverse cardiovascular events and all-cause mortality in obese patients compared to glucagon-like peptide-1 receptor agonists (GLP-1RAs). BMS offers superior cardiovascular protection and improved survival outcomes.

Area of Science:

  • Cardiology
  • Metabolic Surgery
  • Endocrinology

Background:

  • Cardiovascular disease (CVD) is a major global health concern, especially in individuals with obesity and type 2 diabetes mellitus (T2DM).
  • Obesity is a significant risk factor for CVD, necessitating effective management strategies.
  • Current treatments include lifestyle changes, pharmacotherapy, and surgical interventions.

Purpose of the Study:

  • To compare the efficacy of bariatric metabolic surgery (BMS) versus glucagon-like peptide-1 receptor agonists (GLP-1RAs) in improving cardiovascular outcomes and reducing mortality in patients with obesity.
  • To evaluate the impact of BMS and GLP-1RAs on major adverse cardiovascular events (MACE) and all-cause mortality.

Main Methods:

  • A meta-analysis of four observational studies was conducted, including 247,000 patients.
  • Literature search performed in Medline, Embase, and Cochrane CENTRAL up to September 15, 2024.
  • Random effects models were used to calculate pooled risk ratios (RR) and 95% confidence intervals (CI) for primary outcomes.

Main Results:

  • Bariatric metabolic surgery (BMS) was associated with a 29% reduction in major adverse cardiovascular events (MACE) risk compared to GLP-1RAs (RR: 0.71, 95% CI: 0.56-0.90, p = 0.004).
  • BMS demonstrated a 25% reduction in all-cause mortality risk (RR: 0.75, 95% CI: 0.65-0.87, p < 0.0001).
  • These benefits may stem from greater BMI reduction and metabolic improvements following BMS.

Conclusions:

  • Bariatric metabolic surgery (BMS) provides superior cardiovascular protection and improves survival outcomes in obese patients compared to GLP-1RAs.
  • The findings highlight the potential of BMS as a more effective intervention for managing cardiovascular risk in this population.
  • Further research, including randomized controlled trials, is warranted to confirm these results and inform clinical practice.

Keywords:
bariatric metabolic surgerycardiovascular outcomesglp-1 receptor agonistsmeta-analysismortality

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