Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes.

Romeo S, Maglio C, Burza CA, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012;35:2613-2617. 

Exclusive! Vivian Fonseca, MD, provides expert commentary on this post-hoc analysis of SOS.
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Background 

The Swedish Obese Subjects (SOS) study is a nonrandomized, controlled, prospective interventional trial that compares the effects of bariatric surgery and usual care on morbidity and mortality outcomes. Previously published findings from SOS showed that bariatric surgery conferred a reduction in both cardiovascular deaths and incidence of cardiovascular events among the overall SOS population.1  

SOS Post-hoc Analysis Design  

This post-hoc analysis by Romeo and colleagues focuses on cardiovascular events in SOS participants who had type 2 diabetes at baseline (N=607). It is the first prospective report to demonstrate that bariatric surgery reduces the incidence of myocardial infarction among obese individuals with type 2 diabetes.

Participants in the current analysis were aged 37-60 years and had body mass index ≥34 kg/m2 (men) or ≥38 kg/m2 (women). The bariatric surgery group included 345 subjects, who received vertical-banded gastroplasty, gastric banding, or gastric bypass. Those in the usual care (control) group (n=262) received standard care for obesity and type 2 diabetes.

Fatal and nonfatal cardiovascular events (myocardial infarction or stroke, whichever occurred first) were the end points analyzed over mean follow-up of 13.3 years. (Click here for slide.)  

Results  

Patients in the bariatric surgery group experienced fewer fatal and nonfatal cardiovascular events compared with the usual care group. (Click here for slide.)  

  • 63 events/345 subjects in the surgery group (18.3%) vs 65 events/262 subjects in the usual care group (24.8%)
  • Adjusted hazard ratio, 0.53 (95% confidence interval, 0.35-0.79); P=0.002

The incidence of myocardial infarction alone was lower among patients in the surgical group compared with usual care. (Click here for slide.)  

  • 38 events/345 subjects in the surgery group (11.0%) vs 43 events/262 subjects in the usual care group (16.4%)
  • Adjusted hazard ratio, 0.56 (95% confidence interval, 0.34-0.93); P=0.025

Bariatric surgery did not exert any effect on stroke incidence when compared with subjects in the usual-care group. (Click here for slide.)  

  • 34 events/345 subjects in the surgery group (9.9%) vs 24 events/262 subjects in the usual care group (9.2%)
  • Adjusted hazard ratio, 0.73 (95% confidence interval, 0.41-1.30); P=0.29

Type 2 diabetes was defined as fasting blood glucose ≥109.8 mg/dL and/or self-reported use of antihyperglycemic medications at baseline.

1. Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56-65.

Related content: 

Clinical Insights® in Diabetes :: December 2012  

Overview and slides: Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects  

 

December 2012

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest. 

Last Modified: 8/5/2014