Risk of Heart Failure in Obese Patients With and Without Bariatric Surgery in Sweden—A Registry-Based Study

Persson, Christina; Björck, Lena; Lagergren, Jesper; Lappas, Georgios; Giang, Kok Wai; Rosengren, Annika

doi:10.1016/j.cardfail.2017.05.005

Cited by 50 publications

(41 citation statements)

References 30 publications

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“…The literature search identified 18 studies suitable for inclusion [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Fig 1 provides details of the PRISMA flowchart for the literature search.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies used patients with a diagnosis of obesity as the control group, although a group of patients without a diagnosis of obesity was utilised as the control group in 1 study [26]. All studies except this one scored 4 stars for patient selection (rated out of 4) [25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Studies that did not report BMI for control and surgery groups scored only 1 star for comparability [26,28,29,[39][40][41][42].…”

Section: Plos Medicinementioning

confidence: 99%

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Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis

et al. 2020

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Background Previous clinical trials and institutional studies have demonstrated that surgery for the treatment of obesity (termed bariatric or metabolic surgery) reduces all-cause mortality and the development of obesity-related diseases such as type 2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia. The current study analysed large-scale population studies to assess the association of bariatric surgery with long-term mortality and incidence of newonset obesity-related disease at a national level. Methods and findings A systematic literature search of Medline (via PubMed), Embase, and Web of Science was performed. Articles were included if they were national or regional administrative database cohort studies reporting comparative risk of long-term mortality or incident obesity-related diseases for patients who have undergone any form of bariatric surgery compared with an appropriate control group with a minimum follow-up period of 18 months. Meta-analysis of hazard ratios (HRs) was performed for mortality risk, and pooled odds ratios (PORs) were calculated for discrete variables relating to incident disease. Eighteen studies were identified as suitable for inclusion. There were 1,539,904 patients included in the analysis, with 269,818 receiving bariatric surgery and 1,270,086 control patients. Bariatric surgery was associated with a reduced rate of all-cause mortality (POR 0.62, 95% CI 0.55 to 0.69, p < 0.001) and cardiovascular mortality (POR 0.50, 95% CI 0.35 to 0.71, p < 0.001). Bariatric surgery was strongly associated with reduced incidence of T2DM (POR 0.39, 95% CI 0.18 to 0.83, p = 0.010), hypertension (POR 0.36, 95% CI 0.32 to 0.40, p < 0.001), dyslipidaemia (POR 0.33, 95% CI 0.14 to 0.80, p = 0.010), and ischemic heart disease (POR 0.46, 95% CI 0.29 to 0.73, p = 0.001). Limitations of the study include that it was not possible to account for unmeasured variables, which may not have been equally distributed between patient

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Section: Resultsmentioning

confidence: 99%

Section: Plos Medicinementioning

confidence: 99%

Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis

et al. 2020

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“…Additional searches of ClinicalTrials.gov and the reference list of included publications did not yield any further studies not included in the initial search. Of the 12 studies, 318 26 27 compared clinical outcomes in patients with HF undergoing bariatric surgery, 418 26 28 29 investigated heart function and morphology changes in patients with prevalent HF and 730–36 assessed incident HF in obese patients without HF prior to surgery.…”

Section: Resultsmentioning

confidence: 99%

Bariatric surgery among patients with heart failure: a systematic review and meta-analysis

et al. 2018

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BackgroundBariatric surgery reduces cardiovascular risk in obese patients. Heart failure (HF) is associated with an increased perioperative risk following bariatric surgery. This systematic review aimed to assemble the evidence on bariatric surgery in patients with known HF and the potential effect of bariatric surgery on incident HF in obese patients without prevalent HF.MethodsWe performed a comprehensive literature search up to 30 September 2017 and included studies comparing bariatric surgery to non-surgical treatment in patients with known presurgical HF. To assess whether bariatric surgery has any effect on incident HF, we also assembled studies looking at new-onset HF among patients without HF prior to surgery.ResultsWe found five observational studies (0 randomised trials) comparing bariatric surgery with non-surgical treatment in patients with a diagnosis of HF prior to surgery. A review of the available studies (n=676 patients) suggested reduced admission rates for HF exacerbation and increased left ventricular ejection fraction after bariatric surgery. No meta-analysis was possible due to the heterogeneous nature of these studies. Seven studies (one randomised trial) reported data on new-onset HF in obese patients without HF prior to bariatric surgery (n=111 127 patients). When comparing surgical to non-surgical treatment groups, the pooled univariable and multivariable HRs for incident HF were 0.28 (95% CI 0.13 to 0.55) and 0.44 (95% CI 0.36 to 0.55), respectively.ConclusionIn this systematic review, no randomised trial assessed the benefits and risks of bariatric surgery in obese patients with concomitant HF. Available studies do, however, show that surgery might prevent incident HF.

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“…53,81,82 In contrast, marked weight loss (by intensive calorie restriction or bariatric surgery) can decrease both the mass and inflammation of epicardial fat, [83][84][85][86][87][88] and has reduced the burden of AF and restored sinus rhythm in patients with established AF in both observational studies and randomized trials. [89][90][91] Major weight loss also reduces the risk for HF, 92,93 lessens elevated cardiac filling pressures and diastolic filling abnormalities, and improves symptoms and exercise tolerance in patients with latent or overt HFpEF. 53,[94][95][96][97]…”

Section: Effects Of Interventions That Target Epicardial Adipocyte Mamentioning

confidence: 99%

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

Packer

2019

European J of Heart Fail

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Obesity and diabetes can lead to heart failure with preserved ejection fraction (HFpEF), potentially because they both cause expansion and inflammation of epicardial adipose tissue and thus lead to microvascular dysfunction and fibrosis of the underlying left ventricle. The same process also causes an atrial myopathy, which is clinically evident as atrial fibrillation (AF); thus, AF may be the first manifestation of HFpEF. Many patients with apparently isolated AF have latent HFpEF or subsequently develop HFpEF. Most patients with obesity or diabetes who have AF and exercise intolerance have increased left atrial pressures at rest or during exercise, even in the absence of diagnosed HFpEF. Among patients with AF, those who also have latent HFpEF have increased risk for systemic thromboembolism and death. The identification of HFpEF in patients with obesity or diabetes alters the risk‐to‐benefit relationship of commonly prescribed treatments. Bariatric surgery and statins can ameliorate AF and reduce the risk for HFpEF. Conversely, antihyperglycaemic drugs that promote adipogenesis or cause sodium retention (insulin and thiazolidinediones) may increase the risk for heart failure in patients with an underlying ventricular myopathy. Patients with obesity and diabetes who undergo catheter ablation for AF are at increased risk for AF recurrence and for post‐ablation increases in pulmonary venous pressures and worsening heart failure, especially if HFpEF coexists. Therefore, AF may be the earliest indicator of HFpEF in patients with obesity or type 2 diabetes, and recognition of HFpEF alters the management of these patients.

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Risk of Heart Failure in Obese Patients With and Without Bariatric Surgery in Sweden—A Registry-Based Study

Abstract: Patients who underwent bariatric surgery had a reduced risk of heart failure after surgery compared with nonsurgical obese patients.

Cited by 50 publications

References 30 publications

Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis

Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis

Bariatric surgery among patients with heart failure: a systematic review and meta-analysis

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

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