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
. 2024 Sep 1;35(5):721-729.
doi: 10.1097/EDE.0000000000001765. Epub 2024 Jul 18.

Estimating the Effect of Bariatric Surgery on Cardiovascular Events Using Observational Data?

Arin L Madenci  1   2 , Katherine E Kurgansky  3 , Barbra A Dickerman  1 , Hanna Gerlovin  3 , Kerollos Nashat Wanis  1   4 , Ann D Smith  3 , Ludovic Trinquart  5   6 , David R Gagnon  3   7 , Kelly Cho  3 , J Michael Gaziano  3   8 , Juan P Casas  3 , James M Robins  1   9 , Miguel A Hernán  1   9
Affiliations

Estimating the Effect of Bariatric Surgery on Cardiovascular Events Using Observational Data?

Arin L Madenci et al. Epidemiology. .

Abstract

Background: Observational studies have reported strongly protective effects of bariatric surgery on cardiovascular disease, but with oversimplified definitions of the intervention, eligibility criteria, and follow-up, which deviate from those in a randomized trial. We describe an attempt to estimate the effect of bariatric surgery on cardiovascular disease without introducing these sources of bias, which may not be entirely possible with existing observational data.

Methods: We propose two target trials among persons with diabetes: (1) bariatric operation (vs. no operation) among individuals who have undergone preoperative preparation (lifestyle modifications and screening) and (2) preoperative preparation and a bariatric operation (vs. neither preoperative nor operative component). We emulated both target trials using observational data of US veterans.

Results: Comparing bariatric surgery with no surgery (target trial #1; 8,087 individuals), the 7-year cardiovascular risk was 18.0% (95% CI = 6.9, 32.7) in the surgery group and 18.9% (95% CI = 17.7, 20.1) in the no-surgery group (risk difference -0.9, 95% CI = -12.0, 14.0). Comparing preoperative components plus surgery vs. neither (target trial #2; 10,065 individuals), the 7-year cardiovascular risk was 17.4% (95% CI = 13.6, 22.0) in the surgery group and 18.8% (95% CI = 17.8, 19.9) in the no-surgery group (risk difference -1.4, 95% CI = -5.1, 3.2). Body mass index and hemoglobin A1c were reduced with bariatric interventions in both emulations.

Conclusions: Within limitations of available observational data, our estimates do not provide evidence that bariatric surgery reduces cardiovascular disease and support equipoise for a randomized trial of bariatric surgery for cardiovascular disease prevention.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65.
    1. Fisher DP, Johnson E, Haneuse S, et al. Association between bariatric surgery and macrovascular disease outcomes in patients with type 2 diabetes and severe obesity. JAMA. 2018;320:1570–1582.
    1. Aminian A, Zajichek A, Arterburn DE, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA. 2019;322:1271–1282.
    1. Näslund E, Stenberg E, Hofmann R, et al. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with previous myocardial infarction and severe obesity: a nationwide cohort study. Circulation. 2020;143:1458–1467.
    1. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–761.