Bariatric Surgery reduces new onset HF, MI and mortality among elderly

Previous cohort studies demonstrate that bariatric surgery is associated with lower all-cause mortality and a lower risk of incident major adverse cardiovascular events for patients with Class III obesity. However, the long-term effect of bariatric surgery on cardiovascular outcomes in the elderly population is not well studied. Therefore, Dr Amgad Mentias and his team conducted a study to evaluate the association between bariatric surgery and long-term cardiovascular outcomes in the Medicare population.

In this propensity-matched cohort study, the researchers evaluated medicare beneficiaries who underwent bariatric surgery from 2013 to 2019 and matched them to account for 87 clinical variables as potential confounders. The major outcomes assessed were all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. They also used instrumental variable analysis as a part of sensitivity analyses to further control for unmeasured confounders.

Key findings of the study :

• Upon median follow-up of 4.0 years, the researchers found that the bariatric surgery was associated with a lower risk of mortality (9.2 vs 14.7 per 1,000 person-years; HR: 0.63), new-onset HF (HR: 0.46), MI (HR: 0.63) and stroke (HR: 0.71).
• They noted that the benefit of bariatric surgery was evident in patients who were 65 years and older.
• Upon instrumental variable analysis, they found that bariatric surgery was associated with a lower risk of mortality, HF, and MI.

The authors concluded, "Among Medicare beneficiaries with obesity, bariatric surgery is associated with lower risk of mortality, new-onset HF, and MI."

In an accompanying editorial, Dr Tiffany M. Powell-Wiley wrote, "These findings imply that there is the clinical benefit of not only examining cardiovascular outcomes among surgery patients stratified by race but also identifying the role of social determinants of health in disparate cardiovascular outcomes after bariatric surgery. 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."

For further information:

DOI: https://www.jacc.org/doi/10.1016/j.jacc.2022.01.047