Background: Cohort studies showed that bariatric surgery may reduce cardiovascular disease (CVD) incidence, but real-world data from the UK in that regards are limited. Hence, we conducted a population-based study examining the impact of bariatric surgery on incident CVD.
Methods: A retrospective cohort matched-controlled study of adults (1875 years) who had bariatric surgery (Gastric band (GB), sleeve gastrectomy/gastroplasty (SG), gastric bypass (RYGB) and duodenal switch) between 1/1/1990 and 31/1/2018. We utilised The Health Improvement Network (THIN), a validated and representative primary care electronic database. Each exposed patient was matched to 2 controls for age, gender and BMI. CVD was defined as ischemic heart disease (IHD), heart failure (HF), or cerebrovascular disease. Patients with gastric cancer or CVD at baseline were excluded. We conducted Cox regression to analyse the time to event using STATA version15.
Result: The study included 4922 exposed and 9484 control participants, mean age (S.D.) 44.8 (10.4) years, 82.04% were female, 19.9% had diabetes. The median follow- up was 3.83 years (IQR 1.726.34 years). Incident CVD developed in 87 vs 230 patients of the exposed vs. control groups (incident rate 4.3 vs 5.58 per 1000-persons-year respectively). After adjusting for age, gender, baseline BMI, diabetes status, hypertension, smoking, alcohol intake, ethnicity and social deprivation, the adj HR for incident CVD was 0.80 (95%CI 0.62 to 1.02, P=0.074). Examining individual surgical procedure showed that RYGB was associated with reduction in incident CVD with adj HR of 0.53 (95% CI 0.340.81, P=0.003) mainly driven by reduction in incident HF; while GB and SG had neutral/modest non-significant effects. There was statistically non-significant increased risk of stroke noted in GB exposed vs control (1.67, 0.94 to 2.96; P=0.08).
Conclusions: Bariatric surgery was associated with reduction in incident CVD mainly HF. The observed possible increased risk of stroke in GB requires further examinations.
12 Sep 2019 - 13 Sep 2019