Impact of bariatric surgery on cardiovascular outcomes and mortality: a population-based cohort study

Abstract

Background Cohort studies have shown that bariatric surgery may reduce the incidence of and mortality from cardiovascular disease (CVD), but studies using real‐world data are limited. This study examined the impact of bariatric surgery on incident CVD, hypertension and atrial fibrillation, and all‐cause mortality. Methods A retrospective, matched, controlled cohort study of The Health Improvement Network primary care database (from 1 January 1990 to 31 January 2018) was performed (approximately 6 per cent of the UK population). Adults with a BMI of 30 kg/m2 or above who did not have gastric cancer were included as the exposed group. Each exposed patient, who had undergone bariatric surgery, was matched for age, sex, BMI and presence of type 2 diabetes mellitus (T2DM) with two controls who had not had bariatric surgery. Results A total of 5170 exposed and 9995 control participants were included; their mean(s.d.) age was 45·3(10·5) years and 21·5 per cent (3265 of 15 165 participants) had T2DM. Median follow‐up was 3·9 (i.q.r. 1·8– 6·4) years. Mean(s.d.) percentage weight loss was 20·0(13·2) and 0·8(9·5) per cent in exposed and control groups respectively. Overall, bariatric surgery was not associated with a significantly lower CVD risk (adjusted hazard ratio (HR) 0·80; 95 per cent c.i. 0·62 to 1·02; P = 0·074). Only in the gastric bypass group was a significant impact on CVD observed (HR 0·53, 0·34 to 0·81; P = 0·003). Bariatric surgery was associated with significant reduction in all‐cause mortality (adjusted HR 0·70, 0·55 to 0·89; P = 0·004), hypertension (adjusted HR 0·41, 0·34 to 0·50; P < 0·001) and heart failure (adjusted HR 0·57, 0·34 to 0·96; P = 0·033). Outcomes were similar in patients with and those without T2DM (exposed versus controls), except for incident atrial fibrillation, which was reduced in the T2DM group. Conclusion Bariatric surgery is associated with a reduced risk of hypertension, heart failure and mortality, compared with routine care. Gastric bypass was associated with reduced risk of CVD compared to routine care.

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

“…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.…”

“…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].…”

Microbial Adaptation Due to Gastric Bypass Surgery: The Nutritional Impact

“…Bariatric surgery is currently the most effective treatment option for achieving sustained weight loss and the resolution of obesity-related comorbidities, such as T2DM, NAFLD, cardiovascular disease and reduced mortality [9][10][11][12][13]. Bariatric surgery is recommended for individuals with a BMI of ≥ 40 kg/m 2 or a BMI of > 35 kg/m 2 with obesity-related comorbidities [30].…”

“…In particular, there is a difference in the intestinal ratio of Bacteroides and Firmicutes between lean and obese individuals with a greater relative abundance of Firmicutes in obese individuals. At present, only bariatric surgery seems to induce sustained weight loss and resolution of obesity-related morbidities, such as type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), hypertension and cardiovascular disease [8][9][10][11][12][13], relatively attributable to microbial alterations.…”

Long-Term Evaluation of a UK Community Pharmacy-Based Weight Management Service

“…Bariatric surgery where the stomach is operated upon to produce weight loss [10,11] has been shown to be effective. With significant reported average weight losses variable depending on choice of surgery, this approach is often used to reduce diabetes incidence [12], hypertension, heart failure and mortality [13]. The use of invasive surgery, including procedures such as using lap-bands, to expedite weight loss is however a last choice treatment and only for severe obesity.…”