Bariatric Surgery and Long-term Cardiovascular Events

Lars Sjöström, MD, PhD;
Markku Peltonen, PhD;
Peter Jacobson, MD, PhD;
C. David Sjöström, MD, PhD;
Kristjan Karason, MD, PhD;
Hans Wedel, PhD;
Sofie Ahlin, MD;
Åsa Anveden, MD;
Calle Bengtsson, MD, PhD;
Gerd Bergmark, BMA;
Claude Bouchard, PhD;
Björn Carlsson, MD, PhD;
Sven Dahlgren, MD, PhD;
Jan Karlsson, PhD;
Anna-Karin Lindroos, PhD;
Hans Lönroth, MD, PhD;
Kristina Narbro, PhD;
Ingmar Näslund, MD, PhD;
Torsten Olbers, MD, PhD;
Per-Arne Svensson, PhD;
Lena M. S. Carlsson, MD, PhD

[+] Author Affiliations

Author Affiliations: Institutes of Medicine (Drs L. Sjöström, Jacobson, C. Sjöström, Karason, Ahlin, Anveden, B. Carlsson, Svensson, and L. Carlsson and Ms Bergmark), Surgery (Drs Lönroth and Olbers), Primary Health Care (Dr Bengtsson), and Health and Care Sciences (Dr Karlsson), The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Chronic Disease Epidemiology and Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland (Dr Peltonen); Nordic School of Public Health, Gothenburg, Sweden (Dr Wedel); Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge (Dr Bouchard); Department of Surgery, Umeå University Hospital, Umeå, Sweden (Dr Dahlgren); Nutrition Department, National Food Administration, Uppsala, Sweden (Dr Lindroos); Department of Health Care, Region Västra Götaland, Gothenburg, Sweden (Dr Narbro); and Department of Surgery, University Hospital, Örebro, Sweden (Dr Näslund).

Abstract

Context Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking.

Objective To study the association between bariatric surgery, weight loss, and cardiovascular events.

Design, Setting, and Participants The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals.

Main Outcome Measures The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined.

Results Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P < .001).

Conclusion Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.

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