MBS is associated with greater long-term heart risk reduction than GLP-1 medications

Both metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonist (GLP-1RA) medications improve cardiovascular health in people with obesity, but surgery was associated with significantly greater reductions in long-term cardiovascular risk, according to a study by researchers from the Mayo Clinic.

Importantly, researchers say the findings are not about choosing one treatment over another, but about better aligning treatment decisions with long-term health goals.

Omar Ghanem

"This study reinforces that obesity treatment should be viewed as a strategy to reduce cardiovascular risk, not just body weight," said Dr Omar Ghanem, a metabolic surgeon and chair of the Division of Metabolic and Abdominal Wall Reconstructive Surgery at Mayo Clinic in Rochester, and co-authors of the study. "It supports a more individualised, patient-centred approach where treatment decisions are based on long-term health impact."

The retrospective study compared one-year changes in estimated ten-year and lifetime atherosclerotic cardiovascular disease (ASCVD) risk following MBS versus GLP-1RA therapy among adults with obesity. Researchers analysed outcomes for 812 adults with obesity, including 579 who underwent MBS and 233 who received GLP-1 medications between 2020 and 2023 within a large tertiary health care system in the US. Participants were identified from electronic health records and followed for 12 months. Primary outcomes were one-year changes in estimated ten-year and lifetime ASCVD risk. Secondary outcomes included percent total body weight loss, blood pressure, and lipid parameters. Multivariable linear regression models were used to adjust for baseline body mass index and baseline ASCVD risk.

Outcomes

At baseline, patients receiving GLP-1RAs were older and had higher estimated ASCVD risk. At one year, reductions in ten-year ASCVD risk were similar between groups (−0.8% vs. −1.1%; p=0.36). In contrast, lifetime ASCVD risk decreased significantly more following MBS than GLP-1RA therapy (−8.6% vs. −1.7%; p<0.001). MBS was associated with greater percent total body weight loss (−27.8% vs. −11.1%; p<0.001) and more favourable lipid changes, including larger reductions in low-density lipoprotein cholesterol and greater increases in high-density lipoprotein cholesterol. After adjustment, MBS remained independently associated with a greater reduction in lifetime ASCVD risk compared with GLP-1RA therapy (β −6.92; 95% CI −9.22 to −4.62).

The findings may encourage earlier and more balanced discussions about treatment options, including considering surgery as a front-line option for some patients, rather than a last resort, while continuing to support the growing role of effective medications.

"Rather than thinking of these treatments as competing options, we should view them as complementary tools," added Ghanem. "Both surgery and medications play important roles in reducing long-term cardiovascular risk, and the right approach depends on the individual patient."

Researchers note that longer-term studies are needed to evaluate clinical outcomes such as heart attacks, strokes, and survival, as well as the durability of medication-based therapies and the potential benefits of combining surgical and medical approaches.

"Both treatments are effective, but surgery appears to provide a greater reduction in long-term cardiovascular risk, especially when it leads to larger and more sustained weight loss," said Dr Wissam Ghusn, a Mayo Clinic research collaborator and first author of the study.

The findings were featured in the paper, 'Metabolic and Bariatric Surgery vs Glucagon-like peptide-1 Receptor Agonist Therapy - A Head-to-Head Comparison in Improvement of Cardiometabolic Risk Profiles', published in the Annals of Surgery. To access this paper, please click here (log-in maybe required)