Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis

Abstract

Aims: Obesity is a global health problem, associated with significant morbidity and mortality, often due to cardiovascular (CV) diseases. While bariatric surgery is increasingly performed in patients with obesity and reduces CV risk factors, its effect on CV disease is not established. We conducted a systematic review and meta-analysis to evaluate the effect of bariatric surgery on CV outcomes, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

Methods and results: PubMed and Embase were searched for literature until August 2021 which compared bariatric surgery patients to non-surgical controls. Outcomes of interest were all-cause and CV mortality, atrial fibrillation (AF), heart failure (HF), myocardial infarction, and stroke. We included 39 studies, all prospective or retrospective cohort studies, but randomized outcome trials were not available. Bariatric surgery was associated with a beneficial effect on all-cause mortality [pooled hazard ratio (HR) of 0.55; 95% confidence interval (CI) 0.49-0.62, P < 0.001 vs. controls], and CV mortality (HR 0.59, 95% CI 0.47-0.73, P < 0.001). In addition, bariatric surgery was also associated with a reduced incidence of HF (HR 0.50, 95% CI 0.38-0.66, P < 0.001), myocardial infarction (HR 0.58, 95% CI 0.43-0.76, P < 0.001), and stroke (HR 0.64, 95% CI 0.53-0.77, P < 0.001), while its association with AF was not statistically significant (HR 0.82, 95% CI 0.64-1.06, P = 0.12).

Conclusion: The present systematic review and meta-analysis suggests that bariatric surgery is associated with reduced all-cause and CV mortality, and lowered incidence of several CV diseases in patients with obesity. Bariatric surgery should therefore be considered in these patients.

Keywords: Atrial fibrillation; Bariatric surgery; Cardiovascular disease; Heart failure; Metabolic surgery; Myocardial infarction; Obesity; Outcome.

Structured Graphical Abstract

Obesity and cardiovascular disease: the effect of bariatric surgery.

Figure 1

Flowchart of literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. BMI, body mass index; CV, cardiovascular.

Figure 2

Forest plot of pooled hazard ratios of all-cause mortality. CI, confidence interval; DM2, Type 2 diabetes mellitus; RYGB, Roux-en-Y gastric bypass; SE, standard error; SG, sleeve gastrectomy.

Figure 3

Forest plot of pooled hazard ratios of atrial fibrillation, heart failure, myocardial infarction, and stroke. CI, confidence interval; SE, standard error.