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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Beyond the conventional risk factors in the management of atherosclerosis in women: a call to action for careful consideration of obesity and inflammation
Alasnag, M. A., Sambola, A., Uchmanowicz, I., Kałużna, M., Sabouret, P. F., Serrano, L., Paradies, V., Parapid, B. J., Banerjee, S., Bachelot, A., et al. (2026) · European Heart Journal Open · doi:10.1093/ehjopen/oeag055
“67 Ongoing large-scale trials are investigating its impact on MACE, particularly in high-risk populations.”
Risk of stroke after bariatric surgery: a systematic review, meta-analysis and meta-regression
Matar, H. I., Radaideh, D. A., Banat, S. O., Sinjlawi, S. A., Aldeeb, A. M., Bany-Yasin, H., Rasheed, W. M., Almitwali, M. M., & Aldeeb, O. M. (2026) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-026-01148-7
“The analysis of 5 studies [10, 14, 17, 18, 20] including only patients with obesity with type 2 diabetes revealed that bariatric surgery was associated with a lower risk of stroke compared to normal care (RR = 0.77, 95% CI [0.67; 0.88], P < 0.0001).”
Influential
Health care resource utilization and costs associated with obesity classes among patients with heart failure with preserved ejection fraction
Upadhyay, N., Batra, K., Le, L., Steffens, A., Carlyle, M., Song, R., Horstman, T., Ye, W., & Plat, A. W. (2026) · IJC Heart & Vasculature · doi:10.1016/j.ijcha.2026.101939
“[11 – 13].”
GLP-1 receptor agonists and surgical care: implications for bariatric Procedures, perioperative Outcomes, and nutritional optimization
Elawa, Z., Khalil, A., Kardousha, A., Elawwa, A., & Soliman, A. T. (2026) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2026.113332
Initiation of GLP-1 Receptor Agonists Treatment after Bariatric Metabolic Surgery and Major Adverse Cardiac Events
Reges, O., Ahmad, W. A., Ramot, N., Battat, E., Greenland, P., Arbel, R., Sagy, Y. W., Lavie, G., & Diker, D. (2026) · Obesity Facts · doi:10.1159/000551805
“…in patients living with diabetes and obesity, where weight and glycemic control are more difficult to achieve without surgical intervention, BMS reduced incidence of all-cause mortality and MACE compared to nonsurgical interventions [15] even more so than in patients without diabetes [1].”
A 10‐Year Update: Bibliometric Analysis of the Top 100 Papers in Metabolic and Bariatric Surgery
Corpodean, F., Kachmar, M., Popiv, I., Saquer, S., Lovelace, J., Lenhart, D., Cook, M., Aminian, A., COHEN, R. V., Albaugh, V. L., et al. (2026) · Obesity Reviews · doi:10.1111/obr.70146
Self-citation
Stratégies thérapeutiques dans le traitement du diabète de type 2
Bordier, L., & Bauduceau, B. (2026) · EMC - Endocrinologie - Nutrition · doi:10.1016/s1155-1941(25)49531-6
Preoperative Medical Evaluation and Optimization
Ba’th, F., & Wilson, R. L. (2026) · Springer eBooks · doi:10.1007/978-3-032-24278-5_11
Special Patient Populations: Neurologic Disorders
Dan, A. G. (2026) · Springer eBooks · doi:10.1007/978-3-032-24278-5_64
Heart Failure
Suh, S., & Kindel, T. L. (2026) · Springer eBooks · doi:10.1007/978-3-032-24278-5_60
Metabolic Surgery: Outcomes and Choice
Aminian, A. (2026) · Springer eBooks · doi:10.1007/978-3-032-24278-5_10
Self-citation
Pharmacotherapy as Adjunctive Therapy After Bariatric Surgery
Lloyd, S. J., & LaMasters, T. L. (2026) · Springer eBooks · doi:10.1007/978-3-032-24278-5_71
Schwangerschaft mit bariatrischen Voroperationen
Pape-Köhler, C., & Tiegelkamp, A. (2026) · Springer eBooks · doi:10.1007/978-3-662-71193-4_24
Rationale, design, and experiences from the vanguard phase of the bariatric surgery for the reduction of cardiovascular events (BRAVE) trial
Wong, J. A., Conen, D., Doumouras, A., van Reekum, E. A., Bangdiwala, S. I., Balasubramanian, K., Bashir, S., Rangarajan, S., Piché, M., Pettigrew, M., et al. (2026) · American Heart Journal · doi:10.1016/j.ahj.2026.107544
Cardiovascular Safety of Febuxostat vs. Allopurinol in Gout Patients with Cardiovascular Diseases: A Target Trial Emulation
Wang, X., Cheng, X., Wan, Y. W., Wang, Y., Ding, S., & Ying, Z. (2026) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.70403
“15,16 While our study emulated the design of a comparative effectiveness trial using a target trial emulation framework, direct comparisons with RCTs should be interpreted with caution.”
GLP-1 Receptor Agonists in Recurrent Weight Gain after Metabolic Bariatric Surgery
Manyari, Á. A. O., & Manyari, A. L. A. A. A. J. D. O. (2026) · IntechOpen eBooks · doi:10.5772/intechopen.1016875
GLP-1 receptor agonists and bariatric surgery: complement, not competition
Chumakova-Orin, M., Juo, Y.-Y., Fanelli, R. D., Irish, W. D., Pories, W. J., & DeMaria, E. J. (2026) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2026.07.021
Cardiometabolic Syndrome Part 1: Epidemiology, Pathophysiology, and Prevention Strategies
Lim, S. K., Hwang, Y., Son, J. W., Lee, S., Jung, C. H., Kim, H., Lim, H., Jo, S., Ihm, S., Sohn, I. S., et al. (2026) · CardioMetabolic Syndrome Journal · doi:10.51789/cmsj.2026.6.e25
Metabolic dysfunction–associated steatotic liver disease assessment and management: Clinical practice guidance from the Canadian Association for the Study of the Liver
Kehar, M., Ramji, A. S., Swain, M., Singer, A. G., IVERS, N., Schaufert, W., Betel, M., Dasgupta, K., Sebastiani, G., & Patel, K. (2026) · Canadian Liver Journal · doi:10.3138/canlivj-2026-9-3-guidelines
Metabolic and bariatric surgery in adults with obesity and diabetes mellitus: a network meta-analysis
Kiesswetter, E., Gorenflo, L., Schwarzer, G., Stadelmaier, J., Wallerer, S., Marjanovic, G., Fink, J. M., Lehane, C., Metzendorf, M., Meerpohl, J. J., et al. (2026) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015622.pub2
Targeting Overweight and Obesity Phenotypes for Secondary Prevention of Cardiovascular Disease: A Call to Action for the Middle East and Beyond
Almahmeed, W. A., Barajas-Gamboa, J. S., Zubaid, M., Al‐Ozairi, E., Shehab, A., Al‐Rasadi, K., Khalil, C. A., Busaidi, N. A., Sindi, F. A., Awan, Z. A., et al. (2026) · Obesity Reviews · doi:10.1111/obr.70204
Long-term renal, cardiovascular, and survival outcomes in patients with obesity and chronic kidney disease following metabolic and bariatric surgery: a propensity score-matched TriNetX real-world cohort study
Kachornvitaya, P., Zhu, X., Bardaro, S. J., Mocanu, V., Wills, M. V., Barajas-Gamboa, J. S., Lee, Y., Corcelles, R., Strong, A. T., Navarrete, S., et al. (2026) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2026.08.015
Changes in 24-Hour Ambulatory Blood Pressure After Bariatric and Metabolic Surgery in Patients With Morbid Obesity: A Retrospective Cohort Study
Kim, D.-W., & Cho, S. (2026) · Journal of Metabolic and Bariatric Surgery · doi:10.17476/jmbs.2026.15.2.121
“However, most previous studies assessed blood pressure using office measurements or hypertension remission rates [9,10].”
Management of Obesity: Review of Adjunctive Therapies and Clinical Management Pearls
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Impact of bariatric surgery on cardiovascular and cerebrovascular outcomes in metabolic dysfunction–associated steatotic liver disease: a nationwide analysis
Alkasabrah, O. Y., Elzayat, M., Chaudhry, M. Q., Eldesouki, M. H., Ibrahim, S., Serhan, A., & Sharma, T. (2026) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2026.2724644
Comparative Cardiovascular Outcomes of GLP ‐1 Receptor Agonists Versus Bariatric Surgery: A Systematic Review and Network Meta‐Analysis
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The Role of AI in Enhancing the Stapling Efficiency in Metabolic and Bariatric Surgery
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Visceral Adiposity and Renal Health: From Pathophysiological Mechanisms to Novel Therapeutic Strategies
Marqués-Vidas, M., Quiroga, B., Portolés, J. M., Ortíz, A., Fernández‐Fernández, B., Horrillo, A. S., Soler, M. J., García-Carro, C., Morales, E., & Bajo, M. A. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15187201
“BMS significantly lowered MACE risk over 8 years versus medical care [108].”
Adipose Tissue Expandability as a Link Between Nutrition and Obesity-Related Metabolic Risk: Insights from Bariatric Surgery
Jiménez-Flores, E., Reytor-González, C., Gavilanes, D. J., Rossetti, G., Pilone, V., Parrillo, L., Cavallo, M., Cobellis, L., Simancas-Racines, D., & Schiavo, L. (2026) · Nutrients · doi:10.3390/nu18183075
“Bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy, is the most effective treatment for severe obesity, producing weight loss, resolution of T2D, and dramatic reductions in cardiovascular risk [133,134].”

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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