Is there a long-term effect of weight loss surgery on major adverse cardiovascular events in patients with diabetes and hypertension?

This study evaluated the long-term relationship between bariatric surgery (BS; weight loss surgery) and major adverse cardiovascular events (MACE) in patients with obesity, diabetes, and hypertension (high blood pressure; BP). The study showed that a sustained decrease in MACE occurrence was associated with BS in these patients.

Metabolic syndrome is a combination of conditions that occur together and increase the risk of heart disease, stroke, and diabetes. These conditions include diabetes, obesity, hypertension (high BP), high levels of “bad cholesterol” (low-density lipoproteins), and low levels of “good cholesterol” (high-density lipoproteins). MACE refers to an increased risk of heart attacks, strokes, or death.

Bariatric surgery (BS) is used for weight loss in patients with obesity. BS involves making changes to the digestive system in order to lose weight. It has been shown that BS helps in improving blood glucose control and BP in patients with diabetes and hypertension. However, the effect of BS on MACE remains unclear.

This study compared 3627 patients with obesity, diabetes, and/ or hypertension that underwent surgery to 5420 matched controls with obesity. The occurrence of MACE was compared between both groups. Surgical procedures included adjustable gastric band (AGB; involves inserting a silicone band around the stomach to decrease its size), sleeve gastrectomy (SG; removal of a part of the stomach), Roux-en-Y gastric bypass (RYGB; involves bypassing the stomach so the food goes directly to the intestine), and duodenal switch (DS; involves removal of part of the stomach and bypassing the first part of the small intestine). Patients were followed for an average of 7.05 years.

The occurrence of MACE was significantly lower in the long-term in the surgical group (19.6%) compared to controls (24.8%). Patients in the surgical group were 24% less likely to have a MACE compared to controls. There was an absolute risk reduction in MACE of 5.14% over 10 years for the surgical group compared to controls.

The study showed that BS was significantly linked to a lower MACE occurrence in patients with obesity, diabetes, and hypertension.

The study used healthcare datasets that lacked some important weight measurements and clinical information. Patient selection for BS was unlikely to be random. A higher percentage of hypertension occurred among the controls while the surgical group had more patients with diabetes.