The Effects of Bariatric Surgery on Cardiovascular Outcomes and Cardiovascular Mortality: A Systematic Review and Meta-Analysis

Abstract

Obesity is a major public health problem that is associated with serious comorbidities and premature mortality. Cardiovascular disease (CVD) is the major cause of morbidity and mortality associated with obesity. Lifestyle modifications, pharmacological therapy, and weight reduction surgery are the major interventions to date available for obesity management. Bariatric surgery has been increasingly utilized as a therapeutic option for obesity. In this meta-analysis, we aim to assess the effects of bariatric surgery on CVD outcomes and cardiovascular mortality. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Embase, Cochrane Library, Google Scholar, and Web of Science were searched until 03/01/2022. Our search included three types of bariatric surgery: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and gastric banding (GB). All were searched in conjunction with "coronary artery disease," "ischemic heart disease," "myocardial infarction," "cerebrovascular accident," "stroke," "atrial fibrillation," "heart failure," "arrhythmias," and "mortality."We included 49 studies meeting the study criteria. Bariatric surgery showed a beneficial effect on coronary artery disease (CAD) (hazard ratio (HR) of 0.68 {95% confidence interval (CI): 0.52-0.91}, p = 0.008), myocardial infarction (MI) (HR of 0.53 {95% CI: 0.44-0.64}, p < 0.01) heart failure (HF) (HR of 0.45 {95% CI: 0.37-0.55}, p < 0.01), cerebrovascular accident (CVA) (HR of 0.68 {95% CI: 0.59-0.78}, p < 0.01), and cardiovascular mortality (HR of 0.48 {95% CI: 0.40-0.57}, p < 0.01). The effect on atrial fibrillation (AF) did not reach statistical significance: HR of 0.81 (95% CI: 0.65-1.01), p = 0.07. Our study, that is, an updated meta-analysis, including the three types of procedure, confirms beneficial effects on the major CVD outcomes, including coronary artery disease, myocardial infarction, cerebrovascular accident, and heart failure, and on CVD mortality. This study provides updated insights into the long-term CV effects of bariatric surgery, an increasingly common intervention for obesity.

IFSO Consensus on Definitions and Clinical Practice Guidelines for Obesity Management—an International Delphi Study

“…Numerous studies have demonstrated that MBS is significantly more effective than dietary and lifestyle changes alone at inducing weight loss, reducing complications, comorbidities, and mortality, and improving patients’ overall quality of life [ 6 , 8 , 10 , 11 , 22 – 24 ]. Such reductions in complications and comorbidities include improvements in existing conditions and their prevention, including the prevention of various cardiometabolic diseases and cancers demonstrated also in multiple meta-analyses [ 25 – 34 ]. But questions persist as to when MBS might be contraindicated and which procedure to select in different situations.…”

Efectos cardiometabólicos de la pérdida de peso

“…Esta reducción se debe sobre todo a una reducción en la mortalidad de causa CV y por cáncer 40 . La cirugía bariátrica, mediante sleeve gástrico, bypass en Y de Roux o banda gástrica, ha demostrado una menor incidencia en la ECV, el IM, la IC, el ACV, la FA, la mortalidad de causa CV y la mortalidad por todas las causas 40 , 41 . Además, estudios recientes demuestran una mejoría modesta en el remodelado cardíaco tras la cirugía bariátrica 42 .…”

Lo clásico y lo nuevo en el tratamiento del sobrepeso y la obesidad

“…La cirugía metabólica es el tratamiento quirúrgico de reducción de peso que además busca corregir una comorbilidad, como la diabetes o la hipertensión arterial. Es el único tratamiento con evidencia científica que ha demostrado ser eficaz a corto, mediano y largo plazo para lograr, no solamente una importante disminución de peso, sino también una reducción del riesgo cardiovascular global y la mortalidad total [20][21][22] . Si bien hay literatura que menciona que también mejora la calidad de vida, las autoras tenemos ciertas dudas al respecto, por lo menos en relación a que esta mejoría sea 'absoluta', ya que los pacientes pueden pasar de una condición (obesidad con otros factores de riesgo cardiovascular) a otra que describiremos más adelante.…”