Obesity medication use plummets after bariatric surgery; cardiovascular drug use rebounds
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Key takeaways:
- Lipid-lowering and antidiabetic medication use decreased in patients who underwent bariatric surgery vs. those who did not.
- There was a transient reduction cardiovascular medication use in the surgery group.
Patients who underwent bariatric surgery for morbid obesity had a “substantial and long-lasting reduction” of lipid-lowering and antidiabetic medication use compared with patients who did not undergo surgery.
“Bariatric surgery decreases the prevalence of obesity-related diseases, contributing to longer life expectancy and increasing use of such surgery in patients with morbid obesity,” Joonas H. Kauppila, MD, PhD, professor of clinical epidemiology and gastrointestinal surgery consultant at the University of Oulu in Finland, and colleagues wrote in JAMA Surgery. “Yet, it is unclear how bariatric surgery influences the long-term use of medications for obesity-related diseases, ie, hyperlipidemia, cardiovascular disorders and diabetes.”
In a population-based cohort study, Kauppila and colleagues compared 26,396 patients with morbid obesity (median age, 50 years; 66.4% women) who underwent gastric bypass or sleeve gastrectomy with 131,980 matched controls (median age, 50 years; 66.4% women), also diagnosed with morbid obesity, who did not undergo surgery.
The primary outcome was change in lipid-lowering, cardiovascular or antidiabetic medication use.
Lipid-lowering medication
After a median follow-up of 7.1 years in the bariatric surgery group, researchers reported the proportion of patients who used lipid-lowering medication decreased from 20.3% at (95% CI, 20.2-20.5) to 12.9% (95% CI, 12.7-13) 2 years after surgery and 17.6% (95% CI, 13.3-21.8) after 15 years.
After a median follow-up of 5.7 years in the control group, the use of lipid-lowering medications increased from 21% (95% CI, 20.9-21.2) at baseline to 44.6% (95% CI, 41.7-47.5) after 15 years.
Cardiovascular medication
Results also showed that 60.2% (95% CI, 60-60.5) of patients who underwent bariatric surgery used cardiovascular medication at baseline, which decreased after 2 years to 43.2% (95% CI, 42.9-43.4) and increased after 15 years to 74.6% (95% CI, 65.8-83.4).
The use of cardiovascular medication increased among patients who did not undergo surgery from 54.4% (95% CI, 54.3-54.5) at baseline to 83.3% (95% CI, 79.3-87.3) at 15 years.
Antidiabetic medication
At baseline, 27.7% (95% CI, 27.6-27.9) of those in the bariatric surgery group used antidiabetic medication, which decreased to 10% (95% CI, 9.9-10.2) after 2 years and increased to 23.5% (95% CI, 18.5-28.5) after 15 years.
The use of antidiabetic medication increased among patients in the control group from 27.7% (95% CI, 27.6-27.7) at baseline to 54.2% (95% CI, 51-57.5) after 15 years follow-up.
“This large population-based cohort study in Sweden and Finland with up to 23 years of follow-up indicates a long-lasting reduction in the use of lipid-lowering and antidiabetic medication in patients who undergo bariatric surgery compared with matched patients with an obesity diagnosis treated without surgery, while the reduction was only transient for cardiovascular medications,” Kauppila and colleagues concluded.
Perspective
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Jesse Gutnick, MD
This cohort study is impressive in the number of patients involved and the 23-year time frame over which they were followed.
The study results are in line with what previous research has shown after metabolic and bariatric surgery. Over the past few years, we have seen so many of these studies demonstrating clinically impressive improvements in metabolic diseases after weight loss surgery, but we should not lose sight of how significant they are.
In this case, the patients who had usual care had a large increase in the burden of cardiovascular, diabetic and lipid-related diseases, while patients who underwent bariatric surgery had significant improvements in these diseases that persisted over many years.
One should keep in mind that the study’s population group is within Sweden and Finland. It would be good to replicate the research in a more diverse cohort, but often we have to rely on study groups defined by the location where long-term research is possible.
I commend the authors for showing that bariatric and metabolic surgery is a very effective, long-lasting treatment for obesity-related metabolic diseases.
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