Bariatric surgery more effective than GLP-1s at preventing MACE in older patients

Metabolic and bariatric surgery offers significantly greater long-term protection against major adverse cardiovascular events (MACE, eg heart attack, stroke) and death than GLP-1 drugs in older adults with obesity and diabetes, according to real-world analysis study, ‘Cardiometabolic outcomes of metabolic surgery versus GLP-1 receptor agonists in older adults with diabetes and obesity (Abstract ID: 4719)’, presented at the annual meeting of the American Society for Metabolic and Bariatric Surgery.

Thomas H Shin

“While GLP-1 agonists have transformed the treatment landscape for obesity and diabetes, our findings show metabolic and bariatric surgery delivers even greater protection against serious complications including heart attacks, kidney failure and vision loss,” said lead study author, Dr Thomas H Shin, Assistant Professor, Surgery, UVA Health in Charlottesville, Virginia. “What’s more, this study showed advanced age alone should not exclude patients from surgery. In fact, older adults may have the most to gain.”

The study, conducted by researchers at UVA Health, analysed data from more than 200,000 older adults using Epic’s nationwide Cosmos database between 2017 and 2025. Patients undergoing surgery (2,843) had either sleeve gastrectomy or Roux-en-Y gastric bypass while the GLP-1 group (104,437) had either semaglutide, dulaglutide or tirzepatide. After carefully matching patients with similar age, health status and other factors, the final study population exceeded 107,000 patients.

After five years, adults age 65 and older who had bariatric surgery were nearly 16% less likely to develop major adverse cardiovascular events (MACE) compared to those treated with GLP-1 drugs (11.5% vs. 13.6%). The risk of severe kidney disease dropped by more than 25% (9.1% vs. 12.4%) and diabetic retinopathy plummeted by 35% (5.8% vs. 9.0%).

The difference in weight loss between the two treatments was likely the key to the difference in health outcomes. In the first year, surgical patients lost 17.3% of their body weight compared to just 4.2% among GLP-1 users. Notably, blood sugar control (HbA1c) improved similarly in both groups, suggesting superior outcomes with surgery extend beyond glycaemic control alone.

“This study reinforces the notion that metabolic and bariatric surgery is not just about weight loss. It’s a powerful metabolic intervention that can meaningfully change the trajectory of chronic disease in ways no other intervention currently can,” said Dr Richard M Peterson, President, ASMBS and Professor of Surgery at UT Health San Antonio in Texas, who was not involved in the study.