Fisher DP, et al. - In patients with severe obesity and type 2 diabetes (T2D), researchers explored the link between bariatric surgery and incident macrovascular (cerebrovascular diseases and coronary artery disease [CAD]) events. Findings suggested an association of bariatric surgery with a lower risk of incident major macrovascular events. They suggested that medicinal services experts should engage patients with severe obesity and T2D in a shared decision-making conversation about the potential role of bariatric surgery in the prevention of macrovascular events.

Methods

• This was a retrospective, matched cohort study involving patients aged 19-79 years with T2D and severe obesity (body mass index ≥ 35 kg/m²) who either underwent bariatric surgery (n=5,301) from 2005-2011 in 4 integrated health systems in the United States or did not (control participants, n=14,934); they were follow-up through September 2015.
• They compared bariatric procedures (76% Roux-en-Y gastric bypass, 17% sleeve gastrectomy, and 7% adjustable gastric banding) with usual care for T2D.
• Multivariable-adjusted Cox regression analysis explored time to incident macrovascular disease (characterized as first occurrence of CAD [acute myocardial infarction, unstable angina, percutaneous coronary intervention, or coronary artery bypass grafting] or cerebrovascular events [ischemic stroke, hemorrhagic stroke, carotid stenting, or carotid endarterectomy]).
• CAD and cerebrovascular outcomes separately were included secondary outcomes.

Results

• Participant mean (SD) age was 50 (10) years, 76% of the surgical and 75% of the nonsurgical patients were female, and the baseline mean (SD) body mass index measures were 44.7 (6.9) kg/m² and 43.8 (6.7) kg/m² in the surgical and nonsurgical groups, respectively.
• Results revealed that there were 106 macrovascular events in surgical patients (37 cerebrovascular and 78 coronary artery events over a median of 4.7 years; IQR, 3.2-6.2 years) and 596 events in the matched control patients (227 cerebrovascular and 398 coronary artery events over a median of 4.6 years; IQR, 3.1-6.1 years) at the end of the study period.
• Findings suggested an association of bariatric surgery with a lower composite incidence of macrovascular events at 5 years (2.1% in the surgical group vs 4.3% in the nonsurgical group; HR, 0.60 [95% CI, 0.42-0.86]), as well as a lower incidence of CAD (1.6% in the surgical group vs 2.8% in the nonsurgical group; HR, 0.64 [95% CI, 0.42-0.99]).
• Data reported that the incidence of cerebrovascular disease was not significantly different between groups at 5 years (0.7% in the surgical group vs 1.7% in the nonsurgical group; HR, 0.69 [95% CI, 0.38-1.25]).