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Int J Cardiol. 2014 Apr 15;173(1):20-8. doi: 10.1016/j.ijcard.2014.02.026. Epub 2014 Feb 24.

Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis.

Author information

  • 1Cardiovascular Institute, University of Manchester, Manchester, UK. Electronic address: shingkwok@doctors.org.uk.
  • 2Royal Preston Hospital, Fulwood, Preston, UK.
  • 3Cardiovascular Institute, University of Manchester, Manchester, UK.
  • 4School of Medicine & Dentistry, University of Aberdeen, Foresterhill, Aberdeen, UK.
  • 5Norwich Medical School, University of East Anglia, Norwich, UK.

Abstract

BACKGROUND:

Bariatric surgery has been shown to improve cardiovascular risk factors but long term benefits for survival and cardiovascular events are still uncertain.

METHODS:

We searched MEDLINE and EMBASE for parallel group studies that evaluated the clinical outcomes associated with bariatric surgery as compared to non-surgical treatment. Relevant studies were pooled using random effects meta-analysis for risk of myocardial infarction, stroke, cardiovascular events and mortality.

RESULTS:

14 studies met the inclusion criteria, which included 29,208 patients who underwent bariatric surgery and 166,200 nonsurgical controls (mean age 48 years, 30% male, follow up period ranged from 2 years to 14.7 years). Four studies were considered at moderate-high risk of bias, whilst ten studies were at moderate or lower risk of bias. Compared to nonsurgical controls there was more than 50% reduction in mortality amongst patients who had bariatric surgery (OR 0.48 95% CI 0.35-0.64, I2=86%, 14 studies). In pooled analysis of four studies with adjusted data, bariatric surgery was associated with a significantly reduced risk of composite cardiovascular adverse events (OR 0.54 95% CI 0.41-0.70, I2=58%). Bariatric surgery was also associated with significant reduction in specific endpoints of myocardial infarction (OR 0.46 95% CI 0.30-0.69, I2=79%, 4 studies) and stroke (OR 0.49 95% CI 0.32-0.75, I2=59%, 4 studies).

CONCLUSIONS:

Data from observational studies indicates that patients undergoing bariatric surgery have a reduced risk of myocardial infarction, stroke, cardiovascular events and mortality compared to non-surgical controls. Future randomized studies should investigate whether these observations are reproduced in a clinical trials setting.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

Bariatric surgery; Cardiovascular disease; Mortality; Myocardial infarction; Obesity; Stroke

PMID:
24636546
[PubMed - indexed for MEDLINE]
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