The case for bariatric surgery’s cardiovascular benefits was bolstered by a large nationwide cohort study of older people.
Major adverse cardiovascular events were significantly reduced among 94,885 Medicare patients who received surgical treatment for severe obesity compared with matched controls over a median 4 years of follow-up:
- All-cause mortality: 9.2 vs 14.7 per 1,000 person-years, respectively (HR 0.63, 95% CI 0.60-0.66)
- New-onset heart failure: 13.3 vs 27.0 per 1,000 person-years (HR 0.46, 95% CI 0.44-0.49)
- Myocardial infarction (MI): 6.1 vs 9.5 per 1,000 person-years (HR 0.63, 95% CI 0.59-0.68)
- Stroke: 3.5 vs 4.6 per 1,000 person-years (HR 0.71, 95% CI 0.65-0.79)
Bariatric surgery appeared to be protective in this less-studied group of people older than 65, as well as people with no history of diabetes, reported researchers led by Amgad Mentias, MD, MS, of the Cleveland Clinic in Ohio, in the Journal of the American College of Cardiology.
Overall, the number needed to treat to prevent one major adverse cardiovascular event over 3 years was only 15 patients, they noted.
This study is in line with prior research considerably more limited in scope by patient type and geography, which demonstrated the heart and vascular benefits of bariatric surgery based on observational data.
“Among the available tools to combat the obesity epidemic, bariatric surgery has been shown to be one of the most effective treatments not only for weight loss in Class III obesity but also for improving cardiovascular health and outcomes,” wrote Tiffany Powell-Wiley, MD, MPH, and colleagues of the NIH’s National Heart, Lung, and Blood Institute in Bethesda, Maryland, in an accompanying editorial.
Nevertheless, bariatric surgery is still used in less than 1% of potential candidates, Mentias and colleagues noted.
Strategies are needed to reduce barriers to bariatric surgery for communities of color and under-resourced populations experiencing the highest obesity rates, who are the least likely to undergo bariatric procedures, Powell-Wiley’s group urged.
They highlighted the importance of understanding “contextual factors” among candidates of bariatric surgery, citing the potential benefit of lifestyle or social support interventions before and after the procedure.
“Ultimately, the findings of Mentias et al support future work in representative cohorts to identify and implement robust pre- and post-bariatric surgery support programs that address social determinants of obesity and improve cardiovascular health equity,” they wrote.
For their study, Mentias and team matched Medicare patients ages 65 to 75 who underwent bariatric surgery 1:1 to obese controls who did not undergo surgery. The entire cohort had a mean age of 62, and 70% were women. Mean BMI was 44.7 at baseline.
Instrumental variable analysis suggested that bariatric surgery was associated with a lower risk of mortality, heart failure, and MI — but not stroke.
The authors acknowledged that their analysis depended on records being accurately coded in the administrative database, and that they lacked relevant information on weight loss and heart medications that could have been used by the study patients.
In addition, the non-randomized, retrospective nature of the study left room for residual confounding.
Disclosures
The study was supported in part by private philanthropic gifts to Mentias’s institution.
Mentias had no disclosures.
One co-author reported ties to Medtronic and Bristol Myers Squibb.
Powell-Wiley is funded by the National Institute on Minority Health and Health Disparities.
Source: MedicalNewsToday.com
