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

Background Cohort studies have shown that bariatric surgery may reduce the incidence of and mortality from cardiovascular disease (CVD), but studies using real-world data are limited. This study examined the impact of bariatric surgery on incident CVD, hypertension and atrial fibrillation, and all-cause mortality. Methods A retrospective, matched, controlled cohort study of The Health Improvement Network primary care database (from 1 January 1990 to 31 January 2018) was performed (approximately 6 per cent of the UK population). Adults with a BMI of 30 kg/m(2) or above who did not have gastric cancer were included as the exposed group. Each exposed patient, who had undergone bariatric surgery, was matched for age, sex, BMI and presence of type 2 diabetes mellitus (T2DM) with two controls who had not had bariatric surgery. Results A total of 5170 exposed and 9995 control participants were included; their mean(s.d.) age was 45 center dot 3(10 center dot 5) years and 21 center dot 5 per cent (3265 of 15 165 participants) had T2DM. Median follow-up was 3 center dot 9 (i.q.r. 1 center dot 8- 6 center dot 4) years. Mean(s.d.) percentage weight loss was 20 center dot 0(13 center dot 2) and 0 center dot 8(9 center dot 5) per cent in exposed and control groups respectively. Overall, bariatric surgery was not associated with a significantly lower CVD risk (adjusted hazard ratio (HR) 0 center dot 80; 95 per cent c.i. 0 center dot 62 to 1 center dot 02; P = 0 center dot 074). Only in the gastric bypass group was a significant impact on CVD observed (HR 0 center dot 53, 0 center dot 34 to 0 center dot 81; P = 0 center dot 003). Bariatric surgery was associated with significant reduction in all-cause mortality (adjusted HR 0 center dot 70, 0 center dot 55 to 0 center dot 89; P = 0 center dot 004), hypertension (adjusted HR 0 center dot 41, 0 center dot 34 to 0 center dot 50; P < 0 center dot 001) and heart failure (adjusted HR 0 center dot 57, 0 center dot 34 to 0 center dot 96; P = 0 center dot 033). Outcomes were similar in patients with and those without T2DM (exposed versus controls), except for incident atrial fibrillation, which was reduced in the T2DM group. Conclusion Bariatric surgery is associated with a reduced risk of hypertension, heart failure and mortality, compared with routine care. Gastric bypass was associated with reduced risk of CVD compared to routine care.