Bariatric surgery results in significant reductions in cardiovascular deaths and events, according to a new study from Sweden published in JAMA. But one expert cautions that the results do not mean that obese patients without other weight-related complications should undergo surgery.
Analyzing data from more than 4000 obese patients enrolled in the ongoing Swedish Obese Subjects (SOS) study, Lars Sjöström and colleagues found that bariatric surgery was associated with a reduction in cardiovascular events and deaths after a median follow-up of 14.7 years. (The investigators had previously reported a reduction in total mortality in the surgery group.)
- CV deaths: 28 in the surgery group versus 49 in the control group (HR 0.47, CI 0.29- 0.76, p=0.002)
- MI or stroke: 199 versus 234, (HR 0.67, CI 0.54-0.83, p<0.001)
In a surprising finding, the investigators found no significant association between either weight at baseline or weight loss after surgery and cardiovascular events. The authors speculate this may have been due to the low statistical power of the study to detect an association or, alternatively, that the greatest benefit was derived from the initial modest weight loss caused by the surgery.
Taken with previous reports, the results, write the authors, “demonstrate that there are many benefits to bariatric surgery and that some of these benefits are independent of the degree of the surgically induced weight loss.”
In an accompanying editorial, Edward Livingston writes that “because the expected health benefits do not necessarily exceed the risks of weight loss operations, obese patients without other weight-related complications generally should not undergo bariatric surgery.” He suggests that the NIH convene a new expert panel “to rigorously assess the available evidence and provide updated recommendations for bariatric procedures for the treatment of obesity.”
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