Impact of bariatric surgery on cardiovascular outcomes and mortality: a population‐based cohort study

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Background: Cohort studies have shown that bariatric surgery may reduce CVD incidence and mortality, but studies using real world data are limited. We conducted a population-based study examining the impact of bariatric surgery (BS) on incident cardiovascular disease(CVD), hypertension, atrial fibrillation and all-cause mortality. 
Methods: A retrospective matched, controlled cohort study between 1/1/1990 and 31/1/2018 using The Health Improvement Network (THIN), primary care electronic database. Adults with a BMI ≥ 30 kg/m2 who did not have gastric cancer were included in exposed group.Each exposed patient (had BS) was matched for age, sex, body mass index (BMI) & presenceof type 2 diabetes (T2D) to 2 controls (not had BS). 
Results: 5170 exposed and 9995 control participants were included. Mean (SD) age was 45.3(10.5) years, 21.5% (n=3265) had T2D. The median follow-up was 3.9 years (IQR 1.8- 6.4).BS was associated with a lower incident CVD (adjusted HR 0.80; 95%CI 0.62- 1.02,p=0.074), which was statistically significant in the gastric bypass group (0.53, 0.34- 0.81,p=0.003). BS was associated with significant reduction in all-cause mortality (0.70; 95%CI0.55- 0.89, p=0.004), hypertension (0.41; 0.34- 0.50, p<0.001) and heart failure (0.57, 0.34-0.96; p=0.033). Outcomes were similar in those with and without T2D (exposed vs control)except incident AF which was reduced in T2D cohort 
Conclusions: BS was associated with a reduced risk of incident hypertension, CVD, and mortality in real-world data. Improvements in the provision of BS can help reduce the burden of obesity.
Original languageEnglish
Pages (from-to)432-442
JournalBritish Journal of Surgery
Issue number4
Early online date21 Jan 2020
Publication statusE-pub ahead of print - 21 Jan 2020

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