Cited by 505Bariatric Surgery and OutcomesDiabetes, Cardiovascular Risks, and LipoproteinsCardiac, Anesthesia and Surgical Outcomes

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Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity

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Aminian, Ali, Zajichek, Alexander, Arterburn, David E., Wolski, Kathy E., Brethauer, Stacy A., Schauer, Philip R., Kattan, Michael W., Nissen, Steven E.·2019·JAMA

DOI 10.1001/jama.2019.14231PMC PMC6724187

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Abstract

IMPORTANCE: Although metabolic surgery (defined as procedures that influence metabolism by inducing weight loss and altering gastrointestinal physiology) significantly improves cardiometabolic risk factors, the effect on cardiovascular outcomes has been less well characterized. OBJECTIVE: To investigate the relationship between metabolic surgery and incident major adverse cardiovascular events (MACE) in patients with type 2 diabetes and obesity. DESIGN, SETTING, AND PARTICIPANTS: Of 287 438 adult patients with diabetes in the Cleveland Clinic Health System in the United States between 1998 and 2017, 2287 patients underwent metabolic surgery. In this retrospective cohort study, these patients were matched 1:5 to nonsurgical patients with diabetes and obesity (body mass index [BMI] ≥30), resulting in 11 435 control patients, with follow-up through December 2018. EXPOSURES: Metabolic gastrointestinal surgical procedures vs usual care for type 2 diabetes and obesity. MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of extended MACE (composite of 6 outcomes), defined as first occurrence of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, nephropathy, and atrial fibrillation. Secondary end points included 3-component MACE (myocardial infarction, ischemic stroke, and mortality) and the 6 individual components of the primary end point. RESULTS: Among the 13 722 study participants, the distribution of baseline covariates was balanced between the surgical group and the nonsurgical group, including female sex (65.5% vs 64.2%), median age (52.5 vs 54.8 years), BMI (45.1 vs 42.6), and glycated hemoglobin level (7.1% vs 7.1%). The overall median follow-up duration was 3.9 years (interquartile range, 1.9-6.1 years). At the end of the study period, 385 patients in the surgical group and 3243 patients in the nonsurgical group experienced a primary end point (cumulative incidence at 8-years, 30.8% [95% CI, 27.6%-34.0%] in the surgical group and 47.7% [95% CI, 46.1%-49.2%] in the nonsurgical group [P < .001]; absolute 8-year risk difference [ARD], 16.9% [95% CI, 13.1%-20.4%]; adjusted hazard ratio [HR], 0.61 [95% CI, 0.55-0.69]). All 7 prespecified secondary outcomes showed statistically significant differences in favor of metabolic surgery, including mortality. All-cause mortality occurred in 112 patients in the metabolic surgery group and 1111 patients in the nonsurgical group (cumulative incidence at 8 years, 10.0% [95% CI, 7.8%-12.2%] and 17.8% [95% CI, 16.6%-19.0%]; ARD, 7.8% [95% CI, 5.1%-10.2%]; adjusted HR, 0.59 [95% CI, 0.48-0.72]). CONCLUSIONS AND RELEVANCE: Among patients with type 2 diabetes and obesity, metabolic surgery, compared with nonsurgical management, was associated with a significantly lower risk of incident MACE. The findings from this observational study must be confirmed in randomized clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03955952.

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Type 2 diabetes and metabolic surgery guidelines and recommendations should urgently be unified
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Background
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“Such surgical procedures are reported to enhance glucose homeostasis through various mechanisms, including alterations in gut hormones, bile acid metabolism, the microbiota, and glucose metabolism within the gut [9 ].”
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“Metabolic surgery confers an improved risk of mortality as well [133].”
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“[25] Retrospective cohort study The Cleveland Clinic Health System in the United States between 1998 and 2017, 2,287 patients underwent metabolic surgery, and matched 1:5 to non-surgical patients with diabetes and obesity 3-point MACE at 8-years, 30.”
Method
Rate of Cardiovascular Events and Safety Outcomes Seven Years Following Gastric Bypass Versus Sleeve Gastrectomy
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Result
Obesity in Heart Failure with Reduced Ejection Fraction
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Self-citation
The Cardiovascular Events in Metabolic Surgery Compared to the New Classes of Glucose-Lowering Agents in Patients with T2DM
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Self-citation
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“Although not investigated in this study, weight management through metabolic surgery has also been associated with a reduced need for glucose-and blood-pressure-lowering therapies [27], suggesting that modification of disease trajectory in obesity may reduce poly-pharmacy.”
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“Metabolic and bariatric surgery (MBS) has become the mainstay of treatment for severe obesity, due to its established efficacy in achieving significant weight loss and improving obesity-related comorbidities and quality of life [3–5].”
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“…diastolic blood pressure [8] Decrease in LDL and triglycerides and increase in HDL [8] Improvement in metabolic syndrome and cardiovascular events [76] Quality of life (QoL) post-intervention Improvements in overall QoL with better mobility, self-care, decrease in pain although mental health…”
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Authors: Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., Kattan, M. W., & Nissen, S. E.
Affiliations: Cleveland Clinic (US)
Kaiser Permanente Washington Health Research Institute (US)
Corresponding author: Nissen, Steven E.
ORCID: Aminian, Ali
Zajichek, Alexander
Arterburn, David E.
Wolski, Kathy E.
Schauer, Philip R.
Kattan, Michael W.
Nissen, Steven E.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2019-10-01
Volume: 322
Issue: 13
Pages: 1271
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2019.14231
PMC: PMC6724187
OpenAlex: W2970007463
Cited by: 505
References: 32
Citations by year: 2026: 61 · 2025: 71 · 2024: 68 · 2023: 73 · 2022: 66 · 2021: 83 · 2020: 73 · 2019: 9
FWCI: 55.12
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords: metabolic surgery, type 2 diabetes, obesity, major adverse cardiovascular events, cardiovascular outcomes, bariatric surgery, weight loss, myocardial infarction, ischemic stroke, heart failure, atrial fibrillation, kidney disease, mortality, cardiometabolic risk factors

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Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity

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