Bariatric surgery in obese patients was found to be associated with decreased risks for hypertension, heart failure, and all-cause mortality compared with routine care, according to a study published in the British Journal of Surgery.
There is a paucity of real-world data concerning the effect of bariatric surgery on the incidence of cardiovascular disease (CVD) and CVD-related mortality.
In this retrospective matched controlled cohort study, the data of 5170 (mean age, 45.2 years; 80.4% women) adult patients with a body mass index (BMI) >30 kg/m2 who underwent bariatric surgery (exposed group) were examined. Data were collected between 1990 and 2018 from the United Kingdom’s Health Improvement Network database (representing approximately 6% of the population). Patients were matched 2:1 for age, sex, BMI and type 2 diabetes mellitus (T2DM) status with 9995 individuals who did not undergo bariatric surgery (control group; mean age, 45.3 years; 81.1% women).
The primary outcomes were the incidence of a composite of CVD (ie, ischemic heart disease, heart failure [HF], stroke and transient ischemic attack) and all-cause mortality, hypertension, and atrial fibrillation.
The median follow-up time was 3.9 years. A total of 3265 participants (21.5%) had T2DM. The exposed group had a mean weight loss of 20.0% vs 0.8% in the control group.
Roux-en-Y gastric bypass surgery, but not all bariatric surgery, was found to be associated with a reduced CVD risk (Roux-en-Y: adjusted hazard ratio [aHR], 0.53 [95% CI, 0.34-0.81; P =.003]; all surgeries: aHR, 0.80 [95% CI, 0.62-1.02; P =.074]). Participants who underwent bariatric surgery had lower all-cause mortality (aHR, 0.70; 95% CI, 0.55-0.89; P =.004), incident hypertension (aHR, 0.41; 95% CI, 0.34-0.50; P <.001), and HF (aHR, 0.57; 95% CI, 0.34-0.96; P =.033), but not AF (aHR, 0.93; 95% CI, 0.68-1.27; P =.661), compared with participants in the control group. Outcomes were similar in participants with and without T2DM when comparing the exposed and control groups, with the exception of incident AF, which was lower in the T2DM subgroup.
Study strengths include the use of a validated data source and a large sample size. Study limitations include possible residual bias inherent to all observational studies.
“The present study has shown that mortality benefits start to occur relatively early following bariatric surgery. Similarly, the impact on HF, hypertension and CVD also started early during the follow-up, within the first 2 years,” noted the authors.
Singh P, Subramanian A, Adderley N, et al. Impact of bariatric surgery on cardiovascular outcomes and mortality: a population-based cohort study [published online January 21, 2020]. Br J Surg. doi:10.1002/bjs.11433