TY - JOUR
T1 - Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population
AU - Mentias, Amgad
AU - Aminian, Ali
AU - Youssef, Dalia
AU - Pandey, Ambarish
AU - Menon, Venu
AU - Cho, Leslie
AU - Nissen, Steven E.
AU - Desai, Milind Y.
N1 - Funding Information:
The current research was partly funded by philanthropic gifts by the Haslam family, Bailey family, and Khouri family to the Cleveland Clinic for Dr Desai’s research. Dr Desai is a consultant for Medtronic and Bristol Myers Squibb; and is on the executive steering committee of a trial sponsored by Bristol Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/4/19
Y1 - 2022/4/19
N2 - Background: The long-term effect of bariatric surgery on cardiovascular outcomes in the elderly population is not well studied. Objectives: The aim of this study was to evaluate the association between bariatric surgery and long-term cardiovascular outcomes in the Medicare population. Methods: Medicare beneficiaries who underwent bariatric surgery from 2013 to 2019 were matched to a control group of patients with obesity with a 1:1 exact matching based on age, sex, body mass index, and propensity score matching on 87 clinical variables. The study outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. An instrumental variable analysis was performed as a sensitivity analysis. Results: The study cohort included 189,770 patients (94,885 matched patients in each group). By study design, the 2 groups had similar age (mean: 62.33 ± 10.62 years), sex (70% female), and degree of obesity (mean body mass index: 44.7 ± 7.3 kg/m2) and were well balanced on all clinical variables. After a median follow-up of 4.0 years (IQR: 2.4-5.7 years), bariatric surgery was associated with a lower risk of mortality (9.2 vs 14.7 per 1,000 person-years; HR: 0.63; 95% CI: 0.60-0.66), new-onset HF (HR: 0.46; 95% CI: 0.44-0.49), MI (HR: 0.63; 95% CI: 0.59-0.68), and stroke (HR: 0.71; 95%: CI: 0.65-0.79) (P < 0.001). The benefit of bariatric surgery was evident in patients who were 65 years and older. Using instrumental variable analysis, bariatric surgery was associated with a lower risk of mortality, HF, and MI. Conclusions: Among Medicare beneficiaries with obesity, bariatric surgery is associated with lower risk of mortality, new-onset HF, and MI.
AB - Background: The long-term effect of bariatric surgery on cardiovascular outcomes in the elderly population is not well studied. Objectives: The aim of this study was to evaluate the association between bariatric surgery and long-term cardiovascular outcomes in the Medicare population. Methods: Medicare beneficiaries who underwent bariatric surgery from 2013 to 2019 were matched to a control group of patients with obesity with a 1:1 exact matching based on age, sex, body mass index, and propensity score matching on 87 clinical variables. The study outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. An instrumental variable analysis was performed as a sensitivity analysis. Results: The study cohort included 189,770 patients (94,885 matched patients in each group). By study design, the 2 groups had similar age (mean: 62.33 ± 10.62 years), sex (70% female), and degree of obesity (mean body mass index: 44.7 ± 7.3 kg/m2) and were well balanced on all clinical variables. After a median follow-up of 4.0 years (IQR: 2.4-5.7 years), bariatric surgery was associated with a lower risk of mortality (9.2 vs 14.7 per 1,000 person-years; HR: 0.63; 95% CI: 0.60-0.66), new-onset HF (HR: 0.46; 95% CI: 0.44-0.49), MI (HR: 0.63; 95% CI: 0.59-0.68), and stroke (HR: 0.71; 95%: CI: 0.65-0.79) (P < 0.001). The benefit of bariatric surgery was evident in patients who were 65 years and older. Using instrumental variable analysis, bariatric surgery was associated with a lower risk of mortality, HF, and MI. Conclusions: Among Medicare beneficiaries with obesity, bariatric surgery is associated with lower risk of mortality, new-onset HF, and MI.
KW - bariatric surgery
KW - cardiovascular outcomes
KW - obesity
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U2 - 10.1016/j.jacc.2022.01.047
DO - 10.1016/j.jacc.2022.01.047
M3 - Article
C2 - 35422238
AN - SCOPUS:85127335214
SN - 0735-1097
VL - 79
SP - 1429
EP - 1437
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 15
ER -