Bariatric surgery reduces need for lipid-lowering, diabetes medications long term
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Adults with obesity who undergo bariatric surgery are less likely to use lipid-lowering, cardiovascular and diabetes medications after surgery compared with those who do not have surgery, according to study findings.
“The results can aid in informed decision-making when considering bariatric surgery for patients with morbid obesity and inform patients and professionals about the expected long-term effects of medication use for obesity-related comorbidities,” Joonas H. Kauppila, MD, PhD, research fellow in the department of molecular medicine and surgery at Karolinska Institutet in Sweden, and colleagues wrote. “Economically, the long-lasting reductions in medication use for hyperlipidemia, CV morbidity and diabetes suggest that surgical treatment of morbid obesity may infer savings in medication expenses for patients, health care and society.”
Kauppila and colleagues conducted a population-based cohort study of all adults with obesity from 2005 to 2020 in Sweden and from 1995 to 2018 in Finland. Obesity diagnoses and data on bariatric surgery were obtained from patient registries. Adults who underwent gastric bypass or sleeve gastrectomy were matched, 1:5, by country, age, sex, calendar year and medication use with controls who did not undergo surgery. Data on prescriptions were obtained from medication registries. Medications were classified as either lipid-lowering, CV or diabetes. Medication use was analyzed from the time of surgery to the end of follow-up.
The study included 26,396 adults who underwent bariatric surgery and 131,980 who did not (66.4% women; median age, 50 years). The median follow-up time was 7.1 years in the bariatric surgery group and 5.7 years in the control group.
Lipid-lowering medication use declined from 20.3% at baseline to 12.9% at 2 years in the bariatric surgery group before increasing to 14.1% at 5 years and 17.6% at 15 years. The control group had an increase in lipid-lowering medication use from 21% at baseline to 44.6% at 15 years.
At baseline, 60.2% of the surgery group used CV medication. Medication use declined to 43.2% 2 years after surgery, but increased to 47.1% at 5 years and 74.6% at 15 years. The control group had an increase in CV medication use from 54.4% at baseline to 83.3% at 15 years.
Diabetes medication was used by 27.7% of the surgery group at baseline. Use declined to 10% at 2 years before increasing to 13.1% at 5 years and 23.5% at 15 years. The control group had an increase in diabetes medication use from 27.7% at baseline to 54.2% at 15 years.
From baseline to 1 year, the surgery group was less likely have a prescription for a lipid-lowering, CV or diabetes medication than the control group (OR = 0.32; 95% CI, 0.31-0.33). The odds for having a prescription dispensed were even lower for the surgery group at 10 to 15 years compared with the control group (OR = 0.22; 95% CI, 0.2-0.24).
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