Effect of bariatric surgery on long-term cardiovascular outcomes: a nationwide nested cohort study

Abstract

Aims This study aims to evaluate the long-term effect of bariatric surgery on cardiovascular outcomes of patients with obesity. Methods and results A nested cohort study was carried out within the Clinical Practice Research Datalink. The study cohort included the 3701 patients on the database who had undergone bariatric surgery and 3701 age, gender, and body mass index-matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction and fatal or non-fatal ischaemic stroke. Secondary endpoints included fatal or non-fatal myocardial infarction alone, fatal or non-fatal ischaemic stroke alone, incident heart failure, and mortality. The median follow-up achieved was 11.2 years. Patients who had undergone bariatric surgery had a significantly lower occurrence of major adverse cardiovascular events [hazard ratio (HR) 0.410, 95% confidence interval (CI) 0.274–0.615; P < 0.001]. This was mainly driven by a reduction in myocardial infarction (HR 0.412, 95% CI 0.280–0.606; P < 0.001) and not in acute ischaemic stroke (HR 0.536, 95% CI 0.164–1.748; P = 0.301). A reduction was also observed in new diagnoses of heart failure (HR 0.403, 95% CI 0.181–0.897; P = 0.026) and mortality (HR 0.254, 95% CI 0.183–0.353; P < 0.001). Conclusion The results of this large, nationwide cohort study support the association of bariatric surgery with lower long-term risk of major cardiovascular events and incident heart failure in patients with obesity.

Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study

“…This reduction in risk is in line with that reported for the metabolic surgery group in general as well as for patients with T2DM [ 18 – 21 ]. A recent publication by Aminian and colleagues reported a reduction in the risk for MACEs and mortality in patients with T2DM that underwent metabolic surgery [ 20 ].…”

Implications of obesity across the heart failure continuum

“…A nationwide nested cohort study of 7402 patients (3701 undergoing bariatric surgery and 3701 not undergoing surgery) followed-up for a median 11.2 years found that bariatric surgery was associated with significantly lower incidence of fatal and non-fatal myocardial infarction and stroke, lower incident HF and mortality. 68 Bariatric surgery is not discussed in the current American or European HF guidelines, or in the current HT listing guidelines, though these more recent data may suggest bariatric surgery can be used as meaningful therapy, or a bridge to transplant, which has been shown to be safe and effective. 65 , 69.…”

Impacts of bariatric surgery on costs and health outcomes of patients in Brazil: Interrupted time series analysis of multi-panel data

“…Considering that patients were followed during similar periods before (waiting list) and after (follow-up) bariatric surgery for comparison of information pre-and post-intervention, we obtained robust results indicating that bariatric surgery was efficient intervention to interrupt worsening of patients' health conditions, and to promote improvements in health outcomes related to hypertension and diabetes in association with reduction of direct health care costs after treatment, findings in accordance with previous evidence. 15,[19][20][21]23,24 Due to lack of previous evidence regarding impacts of bariatric surgery based on pre-and postintervention costs and multiple health outcomes using micro-costing approach at individual-level, the robust results provided by our estimates may provide real-world foundations for public policy decision making within Brazilian national health system, especially referring to intervention with significant potential for reduction of burden of diseases related to obesity. 71,72 The analysis was conducted on small sample of patients with moderate to severe obesity within one Brazilian hospital of reference who were on the waiting list for bariatric surgery, followed from 6month period before and after the bariatric surgery, extracted from a cohort of approximately 2,000 patients followed during 12 or more years.…”

“…[1][2][3][4][5][6][7][8][9] Considering the rising costs of health care and the escalating burden of obesity in diverse countries, there has been increasing trends in examination of cost-effectiveness of health interventions towards prevention and treatment of obesity and its effects on comorbidities. [10][11][12][13][14][15] Recent evidence on the impacts of obesity-related interventions, including prevention [16][17][18] (promotion of physical activity and healthy eating) and treatment (medication and/or surgical procedures) strategies [19][20][21][22][23][24] , have demonstrated that efficacy of bariatric surgery with multi-disciplinary approach decreasing body weight and improving of health including cancer, cardiovascular events, T2DM, dyslipidemia, life expectancy, and quality of life. 5,23,[25][26][27][28] in the long run.…”

“…24,38,[40][41][42][43][44] To date, most studies focusing on assessment of costs and effectiveness of bariatric surgery in Brazil and other countries have been based on limited sample size and/or single health outcome 5,6,23,38 , or relied on modelling of future outcomes. There is limited evidence including multiple anthropometric, hemodynamic and biochemical parameters of patients 20,22,45 , especially using longitudinal data before and after bariatric surgery 27,46 .…”