Bariatric surgery improves CV outcomes in patients with obesity, obstructive sleep apnea
Key takeaways:
- In patients with obstructive sleep apnea and obesity, weight-loss surgery conferred lower risk for major adverse CV events.
- In that population, the weight-loss surgery group was less likely to die over 10 years.
In adults with obesity and obstructive sleep apnea, bariatric surgery was associated with reduced risk for major adverse CV events compared with no surgery, researchers reported.
“Obstructive sleep apnea is a common problem; it is estimated that nearly 1 billion people in the world have it,” Ali Aminian, MD, director of Bariatric and Metabolic Institute at Cleveland Clinic and a professor of surgery at the Cleveland Clinic Lerner College of Medicine, who presented the findings at the American Society for Metabolic and Bariatric Surgery Annual Scientific Meeting, told Healio. “It is strongly linked with obesity; almost 75% of people with sleep apnea have obesity as an underlying cause. It has been found to be a major risk factor for cardiovascular disease, including heart attack, heart failure and cardiac arrhythmias. We wanted to see, if we helped patients to lose a large amount of weight, can we improve the risk of cardiovascular events in these patients?”
Aminian and colleagues conducted a retrospective single-center analysis of 13,657 patients seen at Cleveland Clinic from 2004 to 2018 who had a BMI of 35 kg/m2 to 70 kg/m2 and moderate to severe obstructive sleep apnea, defined as apnea-hypopnea index of 15 or more events per hour as determined by a sleep study. Among the cohort, 970 had bariatric surgery and the rest did not. Baseline covariates were balanced between the surgery group and the control group after overlap weighting.
The primary outcome was extended major adverse CV events, defined as coronary artery events, cerebrovascular events, HF, atrial fibrillation and mortality. Patients were followed through September 2022.
The surgery group lost approximately 25% of body weight, compared with less than 5% for the control group.
At 10 years, the cumulative incidence of the primary outcome was 27.3% (95% CI, 21.8-32.3) in the surgery group and 34.1% (95% CI, 32.2-35.9) in the control group (adjusted absolute risk difference, 4.2%; 95% CI, 2-11.5; adjusted HR = 0.63; 95% CI, 0.52-0.77; P < .001), Aminian and colleagues found.
All-cause mortality rates were 9.1% in the surgery group and 12.5% in the control group (aHR = 0.63; P < .05), according to the researchers.
“The risk reduction was expected, but that magnitude was surprising,” Aminian told Healio. “However, we see comparable risk reduction in other populations, such as patients with diabetes or fatty liver disease who undergo bariatric surgery. It seems like the weight loss that comes with bariatric surgery can protect these patients’ hearts from developing adverse consequences.”
The findings show that “sleep apnea is another health condition that we need to consider” when counseling patients with obesity, he said. “Now we have a tool that is extremely safe and effective and can help patients with sleep apnea live longer and reduce their risk of cardiovascular events. When we help patients to lose large amounts of weight and keep it off, many of their health conditions will improve, and sleep apnea is one of those.”
He added that “nobody likes to have surgery, but these are extremely safe procedures after which the patient goes home the same day or the next day, and recovery takes about 2 or 3 weeks. The complication rate is about 3%, and the main complications are bleeding, infections, anesthesia problems and blood clots.”
Reference:
- Bariatric surgery cuts risk for major cardiac events and death in patients with obesity and sleep apnea. https://www.eurekalert.org/news-releases/993127. Published June 27, 2023. Accessed June 27, 2023.
Perspective
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A lot of people are not aware how much metabolic/bariatric surgery can decrease mortality. Many people do not realize the risk that obesity poses, especially in patients with sleep apnea, of which there are many. There is a significantly increased risk for multiple complications that comes with sleep apnea, and the fact that there is a treatment that can significantly decrease mortality is a major take-home point. The general public is not aware of this, and even many medical providers are not.
Anybody with moderate or severe obstructive sleep apnea who also has obesity should at least consider metabolic/bariatric surgery. Not every patient is a good candidate for it, but many are, and it is a highly underutilized treatment. A lot of people are afraid of surgery, but the safety of this surgery is very impressive. It is safer than having a gallbladder taken out or a hip replaced. We still are fighting the idea that somehow bariatric surgery is about cosmetics, when really it is about saving lives and changing the body in a way that a person cannot on their own; changing the underlying physiology that can’t be done just by trying harder. More people should be considering surgery because the results are dramatically better than any other alternative we have for treating this disease.
It would help to identify the nuances of the different types of obesity and get people on board with the idea that this is a medical problem that should be treated earlier.
We are entering a new era where people are starting to understand the science of the disease of obesity, and to understand the treatment options for it better. Too many people think that surgery should be a last resort, when in fact, if we use this treatment earlier, we have much better outcomes, and we can dramatically change people’s lives. It is not really intended for people at the last stages of their disease. It is really intended for people earlier in their disease so we can dramatically change what their next 15 to 20 years looks like.
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Aminian A, et al. Top papers I. Presented at: American Society for Metabolic and Bariatric Surgery Annual Scientific Meeting; June 25-29, 2023; Las Vegas.
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