Bariatric surgery cuts risk for CV events, death in older adults with obesity
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Bariatric surgery is associated with significantly lower risk for MI, new-onset HF and death among older adults with obesity, regardless of diabetes status, according to an analysis of Medicare beneficiary data.
Despite evidence that bariatric surgery lowers risk for CV events and death among adults with obesity and diabetes, data are unclear for older patients and patients without diabetes, Amgad Mentias, MD, MSc, assistant professor and clinical cardiologist in the Tomsich Family Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic, told Healio.
“What surprised us was the magnitude of effects of bariatric surgery in this study, which was extremely large,” Mentias told Healio. “Bariatric surgery could decrease the risk for new heart failure by 54%, risk for heart attack by 37%, risk for stroke by 29%, and risk for death by 37% in Medicare beneficiaries with obesity compared with usual nonsurgical care.”
Assessing Medicare data
Mentias and colleagues analyzed data from 94,885 Medicare beneficiaries who underwent bariatric surgery from 2013 to 2019, matched with a control group of 94,885 patients with obesity based on age, sex, BMI and 87 clinical variables. The mean age of both groups was 62 years; mean BMI was 44.7 kg/m2 and 70% were women. Researchers assessed all-cause mortality, new-onset HF, MI and ischemic stroke.
The findings were published in the Journal of the American College of Cardiology.
After a median follow-up of 4 years, bariatric surgery was associated with lower risk for death (HR = 0.63; 95% CI, 0.6-0.66), new-onset HF (HR = 0.46; 95% CI, 0.44-0.49), MI (HR = 0.63; 95% CI, 0.59-0.68) and stroke (HR = 0.71; 95% CI, 0.65-0.79; P < .001 for all).
“These results were consistent in patients younger than 65 years, as well as in patients aged 65 to 75 years,” Mentias told Healio. “They were also consistent in patients with and patients without diabetes.”
Mentias said the data demonstrate that clinicians should discuss the option of bariatric surgery with patients with obesity, even if they are older than 65 years or do not have diabetes.
“Findings of this study indicate the health consequences of obesity on the cardiovascular system are reversible,” Mentias told Healio. “If we help patients to lose a large amount of weight and keep the weight off for an extended period of time, we can decrease the risk for heart attack, heart failure, stroke and death. Bariatric surgery should be considered as a therapeutic strategy to mitigate CV risk among individuals with obesity who are good surgical candidates. Insurance coverage for this important surgery should also be broadened and improved.”
Role of representative cohorts
In a related editorial, Tiffany M. Powell-Wiley, MD, MPH, FAHA, a Stadtman tenure-track investigator and chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory in the division of intramural research at the NHLBI, and colleagues noted the findings, which examine a more representative cohort, imply there is clinical benefit of not only examining CV outcomes among surgery patients stratified by race but also identifying the role of social determinants of health in disparate CV outcomes after bariatric surgery.
“Critically, it provides data on the benefits of bariatric surgery in elderly populations,” Powell-Wiley and colleagues wrote. “To date, this is one of the first studies to support bariatric surgery for CVD risk reduction in patients older than 65 years, a population at highest risk for developing HF. Interestingly, two-thirds of the Medicare population in the study were younger than 65 years of age. Therefore, the study also provides additional evidence on CVD outcomes in bariatric surgery among middle-aged men and women in the United States, a population at increasing risk for premature CVD mortality.”
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For more information:
Amgad Mentias, MD, MSc, can be reached at mentiaa@ccf.org.
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