Aristithes G Doumouras1,2, Jorge A Wong3,4, J Michael Paterson5,2,6, Yung Lee1, Branavan Sivapathasundaram2, Jean-Eric Tarride7,8,9, Lehana Thabane7,4, Dennis Hong1,2, Salim Yusuf3,4, Mehran Anvari1,2. 1. Division of General Surgery (A.G.D., Y.L., D.H., M.A.), McMaster University, Hamilton, Ontario, Canada. 2. ICES, Toronto, Ontario, Canada (A.G.D., J.M.P., B.S., D.H., M.A.). 3. Department of Medicine (J.A.W., S.Y.), McMaster University, Hamilton, Ontario, Canada. 4. Population Health Research Institute, Hamilton Health Sciences and McMaster University, Ontario, Canada (J.A.W., L.T., S.Y.). 5. Department of Family Medicine (J.M.P.), McMaster University, Hamilton, Ontario, Canada. 6. Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada. (J.M.P.). 7. Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences (J.-E.T., L.T.), McMaster University, Hamilton, Ontario, Canada. 8. Center for Health Economics and Policy Analysis (J.-E.T.), McMaster University, Hamilton, Ontario, Canada. 9. Programs for Assessment of Technology in Health, The Research Institute of St Joe's Hamilton, St Joseph's Healthcare Hamilton, Ontario, Canada (J.-E.T.).
Abstract
BACKGROUND: Bariatric surgery has been shown to significantly reduce cardiovascular risk factors. However, whether surgery can reduce major adverse cardiovascular events (MACE), especially in patients with established cardiovascular disease, remains poorly understood. The present study aims to determine the association between bariatric surgery and MACE among patients with cardiovascular disease and severe obesity. METHODS: This was a propensity score-matched cohort study using province-wide multiple-linked administrative databases in Ontario, Canada. Patients with previous ischemic heart disease or heart failure who received bariatric surgery were matched on age, sex, heart failure history, and a propensity score to similar controls from a primary care medical record database in a 1:1 ratio. The primary outcome was the incidence of extended MACE (first occurrence of all-cause mortality, myocardial infarction, coronary revascularization, cerebrovascular events, and heart failure hospitalization). Secondary outcome included 3-component MACE (myocardial infarction, ischemic stroke, and all-cause mortality). Outcomes were evaluated through a combination of matching via propensity score and subsequent multivariable adjustment. RESULTS: A total of 2638 patients (n=1319 in each group) were included, with a median follow-up time of 4.6 years. The primary outcome occurred in 11.5% (151/1319) of the surgery group and 19.6% (259/1319) of the controls (adjusted hazard ratio [HR], 0.58 [95% CI, 0.48-0.71]; P<0.001). The association was notable for those with heart failure (HR, 0.44 [95% CI, 0.31-0.62]; P<0.001; absolute risk difference, 19.3% [95% CI, 12.0%-26.7%]) and in those with ischemic heart disease (HR, 0.60 [95% CI, 0.48-0.74]; P<0.001; absolute risk difference, 7.5% [95% CI, 4.7%-10.5%]). Surgery was also associated with a lower incidence of the secondary outcome (HR, 0.66 [95% CI, 0.52-0.84]; P=0.001) and cardiovascular mortality (HR, 0.35 [95% CI, 0.15-0.80]; P=0.001). CONCLUSIONS: Bariatric surgery was associated with a lower incidence of MACE in patients with cardiovascular disease and obesity. These findings require confirmation by a large-scale randomized trial.
BACKGROUND: Bariatric surgery has been shown to significantly reduce cardiovascular risk factors. However, whether surgery can reduce major adverse cardiovascular events (MACE), especially in patients with established cardiovascular disease, remains poorly understood. The present study aims to determine the association between bariatric surgery and MACE among patients with cardiovascular disease and severe obesity. METHODS: This was a propensity score-matched cohort study using province-wide multiple-linked administrative databases in Ontario, Canada. Patients with previous ischemic heart disease or heart failure who received bariatric surgery were matched on age, sex, heart failure history, and a propensity score to similar controls from a primary care medical record database in a 1:1 ratio. The primary outcome was the incidence of extended MACE (first occurrence of all-cause mortality, myocardial infarction, coronary revascularization, cerebrovascular events, and heart failure hospitalization). Secondary outcome included 3-component MACE (myocardial infarction, ischemic stroke, and all-cause mortality). Outcomes were evaluated through a combination of matching via propensity score and subsequent multivariable adjustment. RESULTS: A total of 2638 patients (n=1319 in each group) were included, with a median follow-up time of 4.6 years. The primary outcome occurred in 11.5% (151/1319) of the surgery group and 19.6% (259/1319) of the controls (adjusted hazard ratio [HR], 0.58 [95% CI, 0.48-0.71]; P<0.001). The association was notable for those with heart failure (HR, 0.44 [95% CI, 0.31-0.62]; P<0.001; absolute risk difference, 19.3% [95% CI, 12.0%-26.7%]) and in those with ischemic heart disease (HR, 0.60 [95% CI, 0.48-0.74]; P<0.001; absolute risk difference, 7.5% [95% CI, 4.7%-10.5%]). Surgery was also associated with a lower incidence of the secondary outcome (HR, 0.66 [95% CI, 0.52-0.84]; P=0.001) and cardiovascular mortality (HR, 0.35 [95% CI, 0.15-0.80]; P=0.001). CONCLUSIONS: Bariatric surgery was associated with a lower incidence of MACE in patients with cardiovascular disease and obesity. These findings require confirmation by a large-scale randomized trial.
Entities:
Keywords:
bariatric surgery; metabolic surgery; population health
Authors: Eduardo Thadeu de Oliveira Correia; Jeffrey I Mechanick; Letícia Mara Dos Santos Barbetta; Antonio José Lagoeiro Jorge; Evandro Tinoco Mesquita Journal: Heart Fail Rev Date: 2022-04-04 Impact factor: 4.214