Anderson, Simon G

Keavney, Bernard D

Khan, Muhammad A

Kwok, Chun Shing

Loke, Yoon K

Mamas, Mamas A

Myint, Phyo Kyaw

Pradhan, Ashish

International Journal of Cardiology

English

Bariatric surgery has been shown to improve cardiovascular risk factors but long term benefits for survival and cardiovascular events are still uncertain

University of East Anglia digital repository

Bariatric surgery and its impact on cardiovascular disease and mortality:a systematic review and meta-analysis

BACKGROUND: Bariatric surgery has been shown to improve cardiovascular risk factors but long term benefits for survival and cardiovascular events are still uncertain. METHODS: We searched MEDLINE and EMBASE for parallel group studies that evaluated the clinical outcomes associated with bariatric surgery as compared to non-surgical treatment. Relevant studies were pooled using random effects meta-analysis for risk of myocardial infarction, stroke, cardiovascular events and mortality. RESULTS: 14 studies met the inclusion criteria, which included 29,208 patients who underwent bariatric surgery and 166,200 nonsurgical controls (mean age 48 years, 30% male, follow up period ranged from 2 years to 14.7 years). Four studies were considered at moderate-high risk of bias, whilst ten studies were at moderate or lower risk of bias. Compared to nonsurgical controls there was more than 50% reduction in mortality amongst patients who had bariatric surgery (OR 0.48 95% CI 0.35-0.64, I2=86%, 14 studies). In pooled analysis of four studies with adjusted data, bariatric surgery was associated with a significantly reduced risk of composite cardiovascular adverse events (OR 0.54 95% CI 0.41-0.70, I2=58%). Bariatric surgery was also associated with significant reduction in specific endpoints of myocardial infarction (OR 0.46 95% CI 0.30-0.69, I2=79%, 4 studies) and stroke (OR 0.49 95% CI 0.32-0.75, I2=59%, 4 studies). CONCLUSIONS: Data from observational studies indicates that patients undergoing bariatric surgery have a reduced risk of myocardial infarction, stroke, cardiovascular events and mortality compared to non-surgical controls. Future randomized studies should investigate whether these observations are reproduced in a clinical trials setting

The University of Manchester - Institutional Repository

Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis.

Chun Shing Kwok

Ashish Pradhan

Muhammad A. Khan

Simon G. Anderson

Bernard D. Keavney

Phyo Kyaw Myint

Mamas A. Mamas

Yoon K. Loke

Crossref

Bariatric surgery and its impact on cardiovascular disease and mortality: A systematic review and meta-analysis

Aberdeen University Research

Adjusted for propensity score. Yes. Likely that controls are potential candidates for surgery. Moderate Peeters

adjusted HR

adjusted HR 0.59 (0.37-0.95) Sjostrom

Bariatric surgery and cardiovascular outcomes: a systematic review.

Bariatric surgery and long-term cardiovascular events.

Bariatric surgery and nonsurgical control seeking bariatric surgery and those recruited from Utah Health Family Tree Program with BMI≥35. Arterburn

Bariatric surgery and nonsurgical treatment control both groups were severely obese adults (BMI>35) with type 2 diabetes. Busetto

Bariatric surgery coded as ICD-9 codes 44.38, 44.39 and 44.95. Surgical controls with orthopaedic procedures and gastrointestinal procedures.

Bariatric surgery compared to nonsurgical treatment and all patients had type 2 diabetes and moderate to severe obese adults.

Bariatric surgery compared to nonsurgical treatment with BMI >35.

Bariatric surgery compared to nonsurgical treatment.

Bariatric surgery compared to nonsurgical treatment. Age 37-60 years and BMI >34 for men and >38 for women. Sowemimo

Bariatric surgery compared to nonsurgical treatment. Patients were >18 years of age and had BMI>35. Peeters

Bariatric surgery compared to orthopaedic and gastrointestinal surgery control. Age 40-79 years with morbid obesity. Sjostrom

Bariatric surgery for morbid obesity.

Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes.

Bariatric surgery versus non-surgical treatment for obesity.

Body weight and glucose metabolism have a different effect on circulating levels of ICAM-1, E-selectin, and endothelin-1 in humans.

Cardiovascular benefits of bariatric surgery in morbidly obese patients. Obes Rev 2011;12:515-24. [10] Loke YK,

Cardiovascular events (fatal or non-fatal MI and stroke) 0.67 (0.54-0.83), MI 0.71 (0.54-0.94), Stroke adjusted HR 0.66 (0.49-0.90). Sowemimo

Changes in leptin, plasminogen activator factor and oxidative stress in morbidly obese patients following open and laparoscopic Swedish adjustable gastric banding. Obes Surg

Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls. Surg Obes Relat Dis

Death adjusted HR 0.76 (0.60-0.96). Peeters

Death obtained from South Carolina Department of Health and Environmental Control's Office of Vital Statistics. No. 1424 excluded (9%). Adjusted for age, gender and history of cardiovascular disease, hyperlipidaemia, and diabetes mellitus.

Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients. Surg Obes Relat Dis

Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidaemia: A systematic review, meta-analysis and meta-regression of 6,587 patients. Obes Surg

Effect of bariatric surgery on comorbidities vs. medical treatment in a cohort of morbidly obese patients: a prospective study.

Effects of bariatric surgery on cardiovascular function.

Effects of changes in body weight and insulin resistance on inflammation and endothelial function in morbid obesity after bariatric surgery.

Endothelial activation markers and their key regulators after restrictive bariatric surgery.

Enterohormonal changes after digestive adaption: five-year results of a surgical proposal to treat obesity and associated disease. Obes Surg

Follow up 15 years. Death adjusted HR 0.67 (0.54-0.85). Gentileschi

Gastric bypass. Hospital diagnosis of morbid obesity.

Health benefits of gastric bypass surgery after 6 years. JAMA 2012;308:1122-1131. [16] Arteburn

ICD=International Classification of Disease, MI=myocardial infarction, BMI=body mass index, HDL=high density lipoproteins Table 3: Treatment groups, follow up and results Study Type of surgery Type of control Follow up Outcomes Adams

Impact of gastric bypass operation on survival: a population-based analysis.

leptin and insulin levels after restrictive surgery: a 2-year follow-up study. Obes Surg

Likely that controls are potential candidates for surgery. Lowmoderate Miranda

Likely that controls are potential candidates for surgery. Moderate Adams

Likely that controls are potential candidates for surgery. Moderate Scott

Likely that controls are potential candidates for surgery. Moderate. Christou

Likely that controls are potential candidates for surgery. Moderate. Unclear loss to follow-up. Gentileschi

Long-term mortality after gastric bypass surgery.

Long-term mortality in patients undergoing bariatric surgery compared to patients managed non-operatively for morbid obesity.

Long-term prevention of mortality in morbid obesity through bariatric surgery: a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass.

Mean of 13.7 to 25.8 months. Adjusted HR after pooling both control arms: MI: 0.54 (0.44-0.67) Stroke:

Measuring inconsistency in metaanalysis.

Natural history of morbid obesity without surgical intervention. Surg Obes Relat Dis

Nonsurgical management of obesity in adults.

Only generalizable to diabetes patients. Moderate. (lowmoderate for composite outcomes) Maciejewski

Only generalizable to diabetes patients. Moderate. Busetto

Prospective cohort study.

Quality of life and obesity. Obes Rev

regional and global trends in adult overweight and obesity prevalences. Popul Health Metr 2012;10:22.

Relation of body mass index in young adulthood and middle age to Medicare expenditures in older age.

Retrospective cohort study.

Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery.

Role of leptin in atherogenesis.

Roux-en-Y gastric bypass surgery performed at the same surgical center. Non-intervened severely obese controls seeking surgery. Median follow up 5.8 years. Crude events death 12/418 vs.

Substantial intentional weight loss and mortality in the severely obese.

Supplement Data 1: Search Strategy Table 1: Study design, sample size and participants Study Design Dates Country Sample size Age % Male Participants Adams

Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients.

Surgical controls used. LowModerate. Sjostrom

Surgical group Control group Deaths in surgical vs. control. CV composite in surgical vs. control. MI in surgical vs. control. Stroke in surgical vs. control. Adams

Surgical patients and patients of similar age with diagnosis of obesity or morbid obesity without surgery.

Surgical patients compared to gender, age and BMI matched patients. Christou

Survival among high-risk patients after bariatric surgery.

The appropriateness of asymmetry tests for publication bias in meta-analysis: a large survey.

The benefit of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ

The potential role of resistin in atherogenesis.

The relationship of soluble ICAM-1, VCAM-1, P-selectin and E-selectin to cardiovascular disease risk factors in healthy men and women.

to 7.2 years. Death: 8/821 vs. 32/821, adjusted RR 0.36 (0.16-0.79). Christou

unadjusted results. Yes. Likely that controls are potential candidates for surgery.

unadjusted results. Yes. Likely that controls are potential candidates for surgery. Moderatehigh Johnson

Up to 2 years. Death: 5/1395 vs. 484/62322, adjusted HR 0.54 (0.22-1.23). Busetto

When can odds ratios mislead?

Bariatric surgery and its impact on cardiovascular disease and mortality : A systematic review and meta-analysis

Bariatric surgery and its impact on cardiovascular disease and mortality : A systematic review and meta-analysis

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