Bariatric Surgery Improves Cerebrovascular Outcomes in Patients With Obesity

PHILADELPHIA — Obese patients who undergo bariatric surgery live longer than those who do not have surgery and are also less likely to have a clot-related stroke, according to research presented at the American Heart Association 2019 Scientific Sessions, held November 16 to 18, in Philadelphia, Pennsylvania.¹

Obesity is associated with a number of cardiovascular risk factors, and bariatric surgery can help reduce these by altering the digestive system to induce weight loss. This retrospective cohort study, the largest study of bariatric surgery to date, analyzed data from the UK’s Clinical Practice Research Datalink on 4212 patients who had undergone bariatric surgery and 4212 controls matched for age, gender, and weight-to-height ratio.

The aim of the study was to examine whether bariatric surgery helps to reduce the long-term risk of major cerebrovascular events. At time of bariatric surgery, none of the patients had previously experienced a stroke.

The primary composite end point for the study was the occurrence of any major adverse cerebrovascular event (ischemic stroke, transient ischemic event, intracranial hemorrhage, and subarachnoid hemorrhage), and secondary end points were all-cause mortality, individual components of the primary end point, composite ischemic events, and hemorrhagic events. Mean length of follow-up was 11.4 years, and investigators used an adjusted Cox proportional hazards model.

In the study, 73 patients experienced the primary end point of major adverse cerebrovascular events, with patients in the bariatric surgery group having significantly lower adjusted rates of major cerebrovascular events (hazard ratio [HR], 0.352; 95% CI, 0.195-0.637).

This reduction in risk was driven by a reduced ischemic event risk (HR, 0.315; 95% CI, 0.156-0.635) but not a reduction in hemorrhagic events (HR, 0.442; 95% CI, 0.147-1.330). Furthermore, 229 patients died during follow-up, and overall all-cause mortality was significantly lower among patients in the bariatric surgery group (HR, 0.323; 95% CI, 0.182-0.570).

Although this study can only show an association and cannot prove causation, study investigators concluded that while bariatric surgery was once seen as an aesthetic procedure, the emerging evidence on its long-term benefits “call for increased awareness and implementation of bariatric surgery as a treatment step for obese patients who are unable to achieve adequate weight loss through lifestyle and medication therapy.”²

References

1. Ardissino M, Moussa O, Heaton T, et al. Bariatric surgery and cerebrovascular outcomes in patients with obesity. Presented at: American Heart Association 2019 Scientific Sessions; November 16-18, 2019; Philadelphia, PA. Abstract 9713.
2. Weight-reduction surgery may prevent strokes, lengthen lives [news release]. Dallas, TX: American Heart Association. Published November 11, 2019. https://newsroom.heart.org/news/weight-reduction-surgery-may-prevent-strokes-lengthen-lives. Accessed November 13, 2019.