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Bariatric Surgery and Cardiovascular Disease

Jun 12, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Brenda Oppong, PharmD Candidate, LECOM School of Pharmacy

A study aims to establish whether bariatric surgery can reduce adverse cardiovascular events. 

Obesity has consistently been linked to an increased risk of developing cardiovascular disease (CVD). Excess body fat is directly related to heart disease. Obesity is associated with increased incidence of myocardial infarction (MI), heart failure (H.F.), stroke, and death. Weight loss is a standard recommendation for patients who have obesity with CVD, but there are limited studies to support the recommendation. The largest trial to date did not show significant benefit from weight loss in cardiovascular morbidity and mortality in patients with obesity and type 2 diabetes (T2D). However, randomized clinical trials revealed that bariatric surgery improves diabetes outcomes in patients with diabetes and severe obesity. A propensity-matched retrospective cohort analyzed the association between bariatric surgery and major adverse cardiovascular events in patients. 

 

Many observational studies have observed a positive correlation between bariatric surgery and decreased cardiovascular outcomes, resulting in a lower risk of macrovascular events in patients with T2D diabetes. The contradiction in results from various studies may be biased, and the studies’ participants received procedures that are no longer common. In recent studies, patients with diabetes and severe obesity underwent sleeve gastrectomy and Roux-en-Y gastric bypass, associated with bariatric surgery with significantly lower cardiovascular events. A population-based matched cohort study used a database from Ontario, and the surgery group consisted of patients from January 2010 to December 2016 who underwent bariatric surgery. The database covers more than 500 family physician practices and more than 500 000 patients with a mean age of 56 years (61% female). Only patients eligible for bariatric surgery were included in the study. Patients who were not Ontario residents, age ≥70 years, BMI <35 kg/m2, history of accessing palliative care, previous solid organ (lung, liver, or heart) transplant, and severe liver disease with ascites within a year of the index date were excluded from the study. The control, nonsurgical patients, were eligible if there was at least one date that the criteria for bariatric surgery could be established. One hospital discharge with ischemic heart disease (IHD) diagnostic or procedure code or at least two physician claims with an IHD diagnosis code within one year was considered a history of IHD. 

Extended major adverse cardiovascular events (MACE) were the primary outcome. The composite of stroke, MI, and all-cause mortality was the primary, secondary outcome. Cause-specific mortality was also evaluated and categorized as cardiovascular or other medical mortality. For safety, 30-day surgical outcomes were assessed. There were 1700 surgical patients, and 1319 were matched to nonsurgical controls in a 1:1 ratio. 548 of the participants had a history of H.F. and the remainder IHD. During a median of 4.5 years of follow-up, there were 151 events (11.5%) in the surgery group and 259 (19.6%) in the control group. The primary outcome was lower in the surgery group than the control group (H.R. was 0.58; 95% CI, 0.48–0.71). The results reported that 40% lower hazard primary events were associated with surgery. 280 patients experienced the secondary outcome, 107 surgery patients and 173 in the control group, with a 34% lower hazard of experiencing the secondary outcome. In patients with heart failure and ischemic heart disease, there was a lower hazard of all outcomes. 

The findings of this study suggest that for patients with established CVD and severe obesity, bariatric surgery lowers MACE incidence. Further studies are needed to confirm the results. 

Practice Pearls: 

  • Bariatric surgery lowers the risk of cardiovascular disease in patients who have diabetes and obesity. 
  • A large-scale randomized trial is needed to confirm the results. 
  • Obesity is linked to a higher incidence of MACE. 

 

DoumourasAristithes G. et al. Bariatric Surgery and Cardiovascular Outcomes in Patients With Obesity and Cardiovascular Disease: A Population-Based Retrospective Cohort Study. CIRCULATIONAHA; April 2021. 

 

Author: Brenda Oppong, PharmD Candidate, LECOM School of Pharmacy