Impact of bariatric surgery on cardiovascular outcomes and mortality: a population‐based cohort study. Issue 4 (21st January 2020)

• Record Type: Journal Article
• Authors: Singh, P.; Subramanian, A.; Adderley, N.; Gokhale, K.; Singhal, R.; Bellary, S.; Nirantharakumar, K.; Tahrani, A. A.
• Is Part Of: British journal of surgery. Volume 107:Issue 4(2020)
• Page Start: 432
• Page End: 442
• Publication Date: 2020-01-21
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.11433
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract : Background: Cohort studies have shown that bariatric surgery may reduce the incidence of and mortality from cardiovascular disease (CVD), but studies using real‐world data are limited. This study examined the impact of bariatric surgery on incident CVD, hypertension and atrial fibrillation, and all‐cause mortality. Methods: A retrospective, matched, controlled cohort study of The Health Improvement Network primary care database (from 1 January 1990 to 31 January 2018) was performed (approximately 6 per cent of the UK population). Adults with a BMI of 30 kg/m 2 or above who did not have gastric cancer were included as the exposed group. Each exposed patient, who had undergone bariatric surgery, was matched for age, sex, BMI and presence of type 2 diabetes mellitus (T2DM) with two controls who had not had bariatric surgery. Results: A total of 5170 exposed and 9995 control participants were included; their mean(s.d.) age was 45·3(10·5) years and 21·5 per cent (3265 of 15 165 participants) had T2DM. Median follow‐up was 3·9 (i.q.r. 1·8– 6·4) years. Mean(s.d.) percentage weight loss was 20·0(13·2) and 0·8(9·5) per cent in exposed and control groups respectively. Overall, bariatric surgery was not associated with a significantly lower CVD risk (adjusted hazard ratio (HR) 0·80; 95 per cent c.i. 0·62 to 1·02; P = 0·074). Only in the gastric bypass group was a significant impact on CVD observed (HR 0·53, 0·34 to 0·81; P = 0·003). Bariatric surgery was associated with significant reduction in all‐cause mortality (adjusted HR 0·70, 0·55 to 0·89; P = 0·004), hypertension (adjusted HR 0·41, 0·34 to 0·50; P < 0·001) and heart failure (adjusted HR 0·57, 0·34 to 0·96; P = 0·033). Outcomes were similar in patients with and those without T2DM (exposed versus controls), except for incident atrial fibrillation, which was reduced in the T2DM group. Conclusion: Bariatric surgery is associated with a reduced risk of hypertension, heart failure and mortality, compared with routine care. Gastric bypass was associated with reduced risk of CVD compared to routine care. Abstract : Bariatric surgery is associated with a reduction in mortality, incident cardiovascular disease (CVD), heart failure and hypertension compared with routine care in patients with and without type 2 diabetes mellitus (T2DM). IHD, ischaemic heart disease; TIA, transient ischaemic attack. Associated with better survival Abstract : Antecedentes: Estudios de cohortes han mostrado que la cirugía bariátrica puede reducir la incidencia de enfermedad cardiovascular ( cardiovascular disease, CVD) y la mortalidad, pero los estudios basados en datos del mundo real son limitados. Este estudio examinaba el impacto de la cirugía bariátrica ( bariatric surgery, BS) en la incidencia de CVD, hipertensión, fibrilación auricular (FA) y mortalidad por cualquier causa. Métodos: Se realizó un estudio retrospectivo de cohortes, controlado por emparejamiento, a partir de la base de datos de atención primaria del The Health Improvement Netwo rk (THIN) (1/1/1990 y 31/1/2018) (aproximadamente el 6% de la población del Reino Unido UK). En el grupo de exposición, se incluyeron adultos con un índice de masa corporal (IMC) ≥ 30 kg/m 2 que no tenían cáncer gástrico. Cada paciente expuesto (había sido operado de BS) fue emparejado por edad, sexo, IMC y presencia de diabetes tipo 2 (T2D) con 2 controles (sin BS). Resultados: Se incluyeron un total de 5.170 sujetos expuestos y 9.995 participantes controles. La edad media (DE) fue 45, 3 (10, 5) años, 21, 5% ( n = 3.265) tenían T2D. La mediana de seguimiento era de 3, 9 años (rango intercuartílico 1, 8‐ 6, 4). La media ± desviación estándar del % de pérdida de peso fue del 20, 0 ± 13, 2% en el grupo BS versus 0, 8 ± 9, 5% en los grupos control. Globalmente, la BS no se asoció con una CVD significativamente más baja (cociente de riesgos instantáneos ajustados, adjusted hazard ratio, HR 0, 80; i.c. del 0, 62‐ 1, 02, P = 0, 074). Solo en el grupo del bypass gástrico se observó un impacto significativo en CVD (0, 53, 0, 34‐ 0, 81, P = 0, 003). BS se asoció con una reducción significativa en la mortalidad de cualquier causa (0, 70; i.c. Del 95% 0, 55‐ 0, 89, P = 0, 004), hipertensión (0, 41; 0, 34‐ 0, 50, P < 0, 001), e insuficiencia cardiaca (0, 57, 0, 34‐ 0, 96; P = 0.033). Los resultados fueron similares en aquellos pacientes con y sin T2D (expuesto versus control) excepto en la FA incidental que se redujo en el grupo T2D. Conclusiones: La práctica de BS se asoció con una reducción del riesgo de insuficiencia cardiaca y mortalidad.