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Bariatric surgery decreased CV risks among obese patients

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Bariatric surgery reduced the long-term incidence of cardiovascular deaths and cardiovascular events such as myocardial infarction and stroke in obese adults, as compared with usual care, according to results from the Swedish Obese Subjects study.

Of 4,047 participants enrolled in the study, 2,010 obese participants underwent bariatric surgery (gastric bypass=13.2%; banding=18.7%; and vertical banded gastroplasty=68.1%) and 2,037 received standard treatment for obesity in the Swedish health care system. To qualify for inclusion, BMI had to be at least 34 in men and at least 38 in women.

After a follow-up of 14.7 years, results revealed a reduced number of CV deaths in the bariatric surgery group vs. the control group (28 events vs. 49 events; HR=0.47; 95% CI, 0.29-0.76). The surgery group also experienced fewer CV events, such as MI or stroke (199 events vs. 234 events; 95% CI, 0.29-0.76). Further, when compared with usual care, bariatric surgery was not associated with incidence of fatal stroke (6 events vs. 12 events; HR=0.49; 95% CI, 0.18-1.3) or the total number of stroke events (93 events vs. 111events; HR=0.82; 95% CI, 0.62-1.08), according to unadjusted analyses. However, after adjusting for baseline conditions, bariatric surgery was associated with a reduced number of fatal stroke (HR=0.34; 95% CI, 0.12-1) and total stroke events (HR=0.66; 95% CI, 0.49-0.9).

Average reductions in body weight after 2, 10, 15 and 20 years were 23%, 17%, 16% and 18% among bariatric surgery patients vs. little or no change among those receiving usual care. However, no relationship between CV events and weight change was found in either group.

“Bariatric surgery is performed with the belief that patients become healthier and that greater longevity is associated with surgically induced weight loss,” Edward H. Livingston, MD, of the division of gastrointestinal and endocrine surgery at the University of Texas Southwestern Medical Center, wrote in an accompanying editorial.

Although bariatric surgery results in weight loss, Livingston said, improved longevity from the surgery still needs to be proven.

“The benefits from bariatric surgery operations are not related to weight loss, the main reason these operations are performed,” Livingston wrote. “Because the expected health benefits do not necessarily exceed the risks of weight loss operations, obese patients without other weight-related complications generally should not undergo bariatric surgery.”

For more information:

• Livingston E. JAMA. 2012;307:88-89.
• Sjöström L. JAMA. 2012;307:56-65.

Disclosure: Various researchers report financial involvement with various companies.

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