Bariatric Surgery and Cardiovascular Outcomes in Patients With Obesity and Cardiovascular Disease:

Abstract

Background: Bariatric surgery has been shown to significantly reduce cardiovascular risk factors. However, whether surgery can reduce major adverse cardiovascular events (MACE), especially in patients with established cardiovascular disease, remains poorly understood. The present study aims to determine the association between bariatric surgery and MACE among patients with cardiovascular disease and severe obesity. Methods: This was a propensity score–matched cohort study using province-wide multiple-linked administrative databases in Ontario, Canada. Patients with previous ischemic heart disease or heart failure who received bariatric surgery were matched on age, sex, heart failure history, and a propensity score to similar controls from a primary care medical record database in a 1:1 ratio. The primary outcome was the incidence of extended MACE (first occurrence of all-cause mortality, myocardial infarction, coronary revascularization, cerebrovascular events, and heart failure hospitalization). Secondary outcome included 3-component MACE (myocardial infarction, ischemic stroke, and all-cause mortality). Outcomes were evaluated through a combination of matching via propensity score and subsequent multivariable adjustment. Results: A total of 2638 patients (n=1319 in each group) were included, with a median follow-up time of 4.6 years. The primary outcome occurred in 11.5% (151/1319) of the surgery group and 19.6% (259/1319) of the controls (adjusted hazard ratio [HR], 0.58 [95% CI, 0.48–0.71]; P <0.001). The association was notable for those with heart failure (HR, 0.44 [95% CI, 0.31–0.62]; P <0.001; absolute risk difference, 19.3% [95% CI, 12.0%–26.7%]) and in those with ischemic heart disease (HR, 0.60 [95% CI, 0.48–0.74]; P <0.001; absolute risk difference, 7.5% [95% CI, 4.7%–10.5%]). Surgery was also associated with a lower incidence of the secondary outcome (HR, 0.66 [95% CI, 0.52–0.84]; P =0.001) and cardiovascular mortality (HR, 0.35 [95% CI, 0.15–0.80]; P =0.001). Conclusions: Bariatric surgery was associated with a lower incidence of MACE in patients with cardiovascular disease and obesity. These findings require confirmation by a large-scale randomized trial.

Effect of Bariatric Surgery on Survival and Hospitalizations in Patients with Severe Obesity. A Retrospective Cohort Study

“…Intriguingly, we found a very low number of deaths in the BS group in the long-term when compared to non-BS controls, in line with another large Italian cohort study [ 35 ]. The reduction of mortality could be justified by the substantial weight loss, leading to the improvement/remission of dysmetabolic abnormalities, cardiovascular, respiratory, renal outcomes, cancer reduced risk, and better motility and quality of life reported after BS [ 3 , 12 , 16 , 17 , 18 , 20 , 22 , 23 , 36 , 37 ]. This is not surprising if the effects of excess fat deposition, such as increased oxidative stress, chronic inflammation, endothelial dysfunction, ectopic lipid deposition, impairments in metabolism and heart, lung, and kidney functions, are considered together with the potential effects of BS in reversing/reducing most of these unfavorable conditions [ 2 ].…”

“…The statistical analyses were conducted trying to reduce the immortal time bias and the effects of several potential confounders. Finally, different to previous studies, where the control cohorts of non-BS patients with obesity were derived from the general population and likely did not receive the same monitoring and treatment of the patients submitted to BS [ 3 , 4 , 7 , 8 , 18 ], our cohort of patients received the same 1-month standardized multidisciplinary program and a follow-up for 12–16 months. This did not prevent the two groups (BS and non-BS) from receiving subsequent different lifestyle and pharmacological treatment, which could have impacted on the measured outcomes.…”

“…More uncertain are the consequences of BS on hospital admissions and healthcare resource use. Many studies reported lower hospital admissions after BS [ 11 , 12 , 13 , 14 , 15 ], suggesting beneficial effects on the chronic conditions characterizing individuals with obesity, such as type 2 diabetes mellitus, cardiovascular risk factors and diseases, chronic sub-clinic inflammation, and some types of cancer [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Other authors reported an increased request for inpatient and nonprimary outpatient care during the first 6-year period, but not thereafter in post-BS patients when compared to controls [ 24 ].…”

Comparative Feasibility of Dobutamine Stress Echocardiography Performed With and Without Intravenous Contrast in Patients With Class Iii Obesity

“…In another recently-published propensity score matched cohort study of 2638 patients with prior CV disease followed for a median of 4.6 years, Doumouras and colleagues reported CV outcomes in 1319 patients with class II and class III obesity undergoing bariatric surgery and 1319 patients who did not undergo bariatric surgery. 20 BMI thresholds were > 35 kg/m 2 with a co-morbidity or [?] 40 kg/m 2 without a co-morbidity.…”

Homeostasis Disrupted and Restored—A Fresh Look at the Mechanism and Treatment of Obesity During COVID-19

“…In this context, it is important to emphasize that bariatric surgery-induced weight loss is a feasible solution to improve metabolic abnormalities, as well as cardiac function. Surgery decreased the incidence of major adverse cardiovascular events by more than 40% among a matched cohort of 2,600 obese patients with cardiac disease and by more than 55% among those with heart failure (32,33). Surgery also decreases the use of antihypertensive drugs (33%), and diet induces a 0.43 mmHg decrease in systolic blood pressure per 1% decrease in body mass index (10, 20, 24).…”