Metabolic Surgery Reduces Risk of Major CV Events in OSA Patients with Obesity: Study

The study, published in the Journal of the American College of Cardiology, showed that metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident major adverse cardiovascular events (MACE) and death in patients with moderate-to-severe obstructive sleep apnea and obesity.

Obstructive sleep apnea, characterized by interruptions in breathing during sleep due to airway obstruction, is closely linked with obesity. Both conditions independently increase the risk of cardiovascular diseases such as hypertension, coronary artery disease, and stroke. Traditional treatments for OSA include continuous positive airway pressure (CPAP) therapy and lifestyle modifications aimed at weight loss.

No therapy has been shown to reduce the risk of MACE and death in patients with OSA. Considering this, Ali Aminian, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, and colleagues aimed to investigate the long-term relationship between metabolic surgery and incident MACE in patients with OSA and obesity.

For this purpose, the researchers identified adult patients with a BMI of 35-70 kg/m2 and moderate-to-severe OSA in a US health system (2004-2018). Patients who underwent metabolic surgery and those in the nonsurgical control group were well-matched in baseline characteristics using overlap weighting methods. Time-to-incident MACE was estimated using multivariable Cox regression analysis, with follow-up concluding in September 2022.

The study led to the following findings:

• The researchers analyzed 13,657 patients (54.9% men; mean age, 52.0 years; median BMI, 41.0), including 970 patients in the metabolic surgery group and 12,687 patients in the nonsurgical group, with a median follow-up of 5.3 years. The mean between-group difference in body weight at ten years was 26.6 kg or 19.3%.
• The 10-year cumulative incidence of MACE was 27.0% in the metabolic surgery group and 35.6% in the nonsurgical group (adjusted HR, 0.58).
• The 10-year cumulative incidence of all-cause mortality was 9.1% in the metabolic surgery group and 12.5% in the nonsurgical group (adjusted HR, 0.63).

In conclusion, the study highlights metabolic surgery as a promising intervention for reducing adverse cardiovascular outcomes in patients with obstructive sleep apnea and obesity. As research continues to evolve, these findings advocate for considering surgical options alongside traditional therapies to optimize health outcomes and improve the quality of life for affected individuals.

Reference:

Aminian, A., Wang, L., Al Jabri, A., Wilson, R., Bena, J., Milinovich, A., Jin, J., Heinzinger, C., Pena-Orbea, C., Foldvary-Schaefer, N., Nissen, S. E., & Mehra, R. (2024). Adverse Cardiovascular Outcomes in Patients with Obstructive Sleep Apnea and Obesity: Metabolic Surgery versus Usual Care. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2024.06.008