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Cited by 305Bariatric Surgery and OutcomesDiabetes, Cardiovascular Risks, and LipoproteinsAirway Management and Intubation Techniques

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Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity

Open access
Fisher, David P., Johnson, Eric, Haneuse, Sebastien, Arterburn, David, Coleman, Karen J., O’Connor, Patrick J., O’Brien, Rebecca, Bogart, Andy, Theis, Mary Kay, Anau, Jane, Schroeder, Emily B., Sidney, Stephen·2018·JAMA
DOI 10.1001/jama.2018.14619PMC PMC6233803
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Abstract

Importance: Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes, and medical management, including lifestyle changes, may not be successful at lowering risk. Objective: To investigate the relationship between bariatric surgery and incident macrovascular (coronary artery disease and cerebrovascular diseases) events in patients with severe obesity and type 2 diabetes. Design, Setting, and Participants: In this retrospective, matched cohort study, patients with severe obesity (body mass index ≥35) aged 19 to 79 years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4 integrated health systems in the United States (n = 5301) were matched to 14 934 control patients on site, age, sex, body mass index, hemoglobin A1c, insulin use, observed diabetes duration, and prior health care utilization, with follow-up through September 2015. Exposures: Bariatric procedures (76% Roux-en-Y gastric bypass, 17% sleeve gastrectomy, and 7% adjustable gastric banding) were compared with usual care for diabetes. Main Outcomes and Measures: Multivariable-adjusted Cox regression analysis investigated time to incident macrovascular disease (defined as first occurrence of coronary artery disease [acute myocardial infarction, unstable angina, percutaneous coronary intervention, or coronary artery bypass grafting] or cerebrovascular events [ischemic stroke, hemorrhagic stroke, carotid stenting, or carotid endarterectomy]). Secondary outcomes included coronary artery disease and cerebrovascular outcomes separately. Results: Among a combined 20 235 surgical and nonsurgical patients, the mean (SD) age was 50 (10) years; 76% of the surgical and 75% of the nonsurgical patients were female; and the baseline mean (SD) body mass index was 44.7 (6.9) and 43.8 (6.7) in the surgical and nonsurgical groups, respectively. At the end of the study period, there were 106 macrovascular events in surgical patients (including 37 cerebrovascular and 78 coronary artery events over a median of 4.7 years; interquartile range, 3.2-6.2 years) and 596 events in the matched control patients (including 227 cerebrovascular and 398 coronary artery events over a median of 4.6 years; interquartile range, 3.1-6.1 years). Bariatric surgery was associated with a lower composite incidence of macrovascular events at 5 years (2.1% in the surgical group vs 4.3% in the nonsurgical group; hazard ratio, 0.60 [95% CI, 0.42-0.86]), as well as a lower incidence of coronary artery disease (1.6% in the surgical group vs 2.8% in the nonsurgical group; hazard ratio, 0.64 [95% CI, 0.42-0.99]). The incidence of cerebrovascular disease was not significantly different between groups at 5 years (0.7% in the surgical group vs 1.7% in the nonsurgical group; hazard ratio, 0.69 [95% CI, 0.38-1.25]). Conclusions and Relevance: In this observational study of patients with type 2 diabetes and severe obesity who underwent surgery, compared with those who did not undergo surgery, bariatric surgery was associated with a lower risk of macrovascular outcomes. The findings require confirmation in randomized clinical trials. Health care professionals should engage patients with severe obesity and type 2 diabetes in a shared decision making conversation about the potential role of bariatric surgery in the prevention of macrovascular events.

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Authors
Fisher, D. P., Johnson, E., Haneuse, S., Arterburn, D., Coleman, K. J., O’Connor, P. J., O’Brien, R., Bogart, A., Theis, M. K., Anau, J., Schroeder, E. B., & Sidney, S.
Affiliations
  • Kaiser Permanente (US)
  • Kaiser Permanente Washington Health Research Institute (US)
  • Harvard University (US)
  • HealthPartners (US)
  • RAND Corporation (US)
Corresponding author
Arterburn, David
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2018-10-16
Volume
320
Issue
15
Pages
1570
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2018.14619
PMC
PMC6233803
OpenAlex
W2897791360
Cited by
305
References
33
Citations by year
2026: 20 · 2025: 29 · 2024: 42 · 2023: 37 · 2022: 40 · 2021: 44 · 2020: 52 · 2019: 37 · 2018: 3
FWCI
35.33
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK099237, R01DK105960, R01DK092317, P30DK092924)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
Keywords
bariatric surgery, type 2 diabetes, morbid obesity, macroangiopathy, coronary artery disease, cerebrovascular disease, Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, acute myocardial infarction, ischemic stroke, hemorrhagic stroke, carotid endarterectomy, carotid artery stenting, matched cohort, body mass index
MeSH terms
Adult, Aged, Cerebrovascular Disorders, Coronary Disease, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Obesity, Morbid, Retrospective Studies, Risk, Proportional Hazards Models, Bariatric Surgery

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