Bariatric surgery is associated with a statistically significant risk reduction of coronary artery disease (CAD), myocardial infarction (MI), heart failure (HF) and cerebrovascular accident (CVA), according to findings from a systematic review and meta-analysis by researchers from in New York. The findings were featured in the paper, 'The Effects of Bariatric Surgery on Cardiovascular Outcomes and Cardiovascular Mortality: A Systematic Review and Meta-Analysis', published in Cureus.
The investigators carried out the meta-analysis to assess the effects of bariatric surgery on cardiovascular disease (CVD) outcomes and cardiovascular mortality, and included outcomes from Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and gastric banding (GB). The researchers included 49 studies; 32 studies were retrospective cohort studies, and other were prospective or population-based studies.
Seven studies reported effects on CAD, including 17,423 bariatric surgery patients and 43,507 controls. The effect on CAD was significant with a pooled HR of 0.68 (95% CI: 0.52-0.91) (p=0.008). Twenty-two studies reported myocardial infarction outcomes, including 23,1503 patients in the intervention group and 487,727 in the control group. The effect on MI was significant with a pooled HR of 0.53 (95% CI: 0.44-0.64) (p<0.01).
Eighteen studies reported heart failure outcomes, including 18,0961 in the intervention group and 202,891 in the control group. The effect on heart failure was significant with a pooled HR of 0.45 (95% CI: 0.37-0.55) (p<0.01). Eight studies reported atrial fibrillation outcomes, including 18,309 in the intervention group and 32,933 in the control group. The effect on atrial fibrillation was not significant with a pooled HR of 0.81 (95% CI: 0.65-1.01) (p=0.07 Twenty-three studies reported cerebrovascular accident (CVA) outcomes, including 238,472 subjects and 513,848 controls. The effect on CVA was significant with a pooled HR of 0.68 (95% CI: 0.59-0.78) (p<0.01).
Twenty-six studies reported cardiovascular disease-specific mortality, including 157,750 in the surgery group and 643,770 in the control groups. The effect on cardiovascular disease (CVD) mortality was significant with a pooled HR of 0.48 (95% CI: 0.40-0.57) (p<0.01).
“In this updated meta-analysis, we analysed six major long-term cardiovascular outcomes post-bariatric surgery. Five outcomes including CAD, MI, HF, CVA, and CVD mortality showed a significant risk reduction, whereas atrial fibrillation showed a non-significant risk reduction,” the authors stated.
“Although the management of obesity requires a multimodal approach, recognizing the necessity for bariatric surgery early in the disease course is important. Both the physician and the patients should be aware of the treatment strategies to make a well-informed decision…” the authors concluded. “Further research needs to be conducted to determine if these individual procedures have better overall outcomes than one another.”
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