Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Oct 12;13(10):3568.
doi: 10.3390/nu13103568.

Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Patients with Obesity and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Andryanto Sutanto  1   2 , Citrawati Dyah Kencono Wungu  3   4 , Hendri Susilo  5 , Henry Sutanto  6
Affiliations
Meta-Analysis

Reduction of Major Adverse Cardiovascular Events (MACE) after Bariatric Surgery in Patients with Obesity and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Andryanto Sutanto et al. Nutrients. .

Abstract

Cardiovascular diseases (CVDs) are the leading cause of death worldwide and obesity is a major risk factor that increases the morbidity and mortality of CVDs. Lifestyle modifications (e.g., diet control, physical exercise and behavioral changes) have been the first-line managements of obesity for decades. Nonetheless, when such interventions fail, pharmacotherapies and bariatric surgery are considered. Interestingly, a sudden weight loss (e.g., due to bariatric surgery) could also increase mortality. Thus, it remains unclear whether the bariatric surgery-associated weight reduction in patients with obesity and CVDs is beneficial for the reduction of Major Adverse Cardiovascular Events (MACE). Here, we performed a systematic literature search and meta-analysis of published studies comparing MACE in patients with obesity and CVDs who underwent bariatric surgery with control patients (no surgery). Eleven studies, with a total of 1,772,305 patients, which consisted of 74,042 patients who underwent any form of bariatric surgery and 1,698,263 patients with no surgery, were included in the systematic review. Next, the studies' data, including odds ratio (OR) and adjusted hazard ratio (aHR), were pooled and analyzed in a meta-analysis using a random effect model. The meta-analysis of ten studies showed that the bariatric surgery group had significantly lower odds of MACE as compared to no surgery (OR = 0.49; 95% CI 0.40-0.60; p < 0.00001; I2 = 93%) and the adjustment to confounding variables in nine studies revealed consistent results (aHR = 0.57; 95% CI 0.49-0.66; p < 0.00001; I2 = 73%), suggesting the benefit of bariatric surgery in reducing the occurrence of MACE in patients with obesity and CVDs (PROSPERO ID: CRD42021274343).

Keywords: bariatric surgery; cardiovascular disease; major adverse cardiovascular events; meta-analysis; obesity; risk factor; systematic review; weight intervention.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Commonly performed bariatric surgery procedures: (A) gastric banding; (B) vertical banded gastroplasty; (C) sleeve gastrectomy; (D) Roux-en-Y gastric bypass.
Figure 2
Figure 2
The PRISMA flow diagram of the literature search.
Figure 3
Figure 3
Risk of bias assessment with the Newcastle–Ottawa Scale (NOS).
Figure 4
Figure 4
Forest plot of the MACE incidence comparing bariatric surgery with no surgery.
Figure 5
Figure 5
Begg’s funnel plot for publication bias assessment.
Figure 6
Figure 6
Forest plot of the MACE incidence comparing bariatric surgery with no surgery excluding studies with an unequal sample size between the arms.
Figure 7
Figure 7
Adjusted forest plot of the MACE incidence comparing bariatric surgery with no surgery.
Figure 8
Figure 8
Adjusted Begg’s funnel plot for publication bias assessment.
See this image and copyright information in PMC

References

    1. Roth G.A., Mensah G.A., Johnson C.O., Addolorato G., Ammirati E., Baddour L.M., Barengo N.C., Beaton A.Z., Benjamin E.J., Benziger C.P., et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. J. Am. Coll. Cardiol. 2020;76:2982–3021. doi: 10.1016/j.jacc.2020.11.010. - DOI - PMC - PubMed
    1. Yusuf S., Reddy S., Ounpuu S., Anand S. Global burden of cardiovascular diseases: Part I: General considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104:2746–2753. doi: 10.1161/hc4601.099487. - DOI - PubMed
    1. Powell-Wiley T.M., Poirier P., Burke L.E., Despres J.P., Gordon-Larsen P., Lavie C.J., Lear S.A., Ndumele C.E., Neeland I.J., Sanders P., et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;143:e984–e1010. doi: 10.1161/CIR.0000000000000973. - DOI - PMC - PubMed
    1. Pabon M.A., Manocha K., Cheung J.W., Lo J.C. Linking Arrhythmias and Adipocytes: Insights, Mechanisms, and Future Directions. Front. Physiol. 2018;9:1752. doi: 10.3389/fphys.2018.01752. - DOI - PMC - PubMed
    1. Fock K.M., Khoo J. Diet and exercise in management of obesity and overweight. J. Gastroenterol. Hepatol. 2013;28((Suppl. 4)):59–63. doi: 10.1111/jgh.12407. - DOI - PubMed