Metabolic surgery associated with reduced risk of incident major adverse cardiovascular events in individuals with Type 2 diabetes and obesity

Compared with patients who received standard, non-surgical care, individuals with Type 2 diabetes and obesity who underwent metabolic surgery had improved diabetes control, reduced risk of incident major adverse cardiovascular events and medication requirement.

Individuals with obesity and co-incident Type 2 diabetes often have increased risks of experiencing adverse cardiovascular events and/or related mortality. In a novel retrospective, observational study, researchers from the Cleveland Clinic (OH, USA) have analyzed data on more than 13,000 individuals with diabetes and obesity and observed that those who underwent ‘metabolic’ surgery lost more weight, had improved diabetes control and required fewer diabetes and cardiovascular medications, compared with patients who received standard medical treatments.

Close to 40% of adult American population is classified as obese. Obesity is often co-morbid with indications such as Type 2 diabetes, heart failure or stroke. Adults with Type 2 diabetes may be up to four times more likely to die as a result of cardiovascular disease compared with individuals who do not have diabetes.

In the study, researchers compared data on 2287 individuals with diabetes and obesity from the Cleveland Clinic Health System who underwent one of the four major metabolic surgeries listed with 11,435 diabetic and characteristically matched comparators who received standard pharmacotherapy treatment.

The primary study endpoint was the occurrence of all-cause mortality or any one of five major complications known to be associated with co-incident diabetes and obesity: kidney disease, atrial fibrillation, coronary artery events, heart failure and cerebrovascular events.

The median follow-up duration was 3.9 years; metabolic surgery was associated with lower risks of all-cause mortality and incident major adverse cardiovascular events.

However, due to the observational nature of the data, nonrandomized study design and potential for confounding, further research is required to substantiate and confirm any association between metabolic surgery and major adverse cardiovascular event risk reduction, including the conduct of randomized-controlled trials.

Steven Nissen, senior study author and Chief Academic Officer of the Heart & Vascular Institute at Cleveland Clinic, commented: “Cardiovascular complications from obesity and diabetes can be devastating. Now that we’ve seen these remarkable results, a well-designed randomized controlled trial is needed to definitively determine whether metabolic surgery can reduce the incidence of major heart problems in patients with type 2 diabetes and obesity.”

In the study, the authors note: “…given the observational nature of the study, these data should be considered hypothesis-generating and not conclusive.”

Sources:

Aminian A, Zajichek A, Arterburn DE et al. Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity. JAMA. doi:10.1001/jama.2019.14231 (Epub ahead of print) (2019); https://newsroom.clevelandclinic.org/2019/09/02/weight-loss-surgery-associated-with-40-reduction-in-risk-of-death-and-heart-complications-in-patients-with-diabetes-and-obesity-study-shows/