Better cardiovascular outcomes with gastric bypass vs sleeve gastrectomy
medwireNews: Among people with type 2 diabetes and obesity who undergo metabolic surgery, Roux-en-Y gastric bypass (RYGB) is associated with a lower risk for major adverse cardiovascular events (MACE) than sleeve gastrectomy (SG), suggests a secondary analysis of a cohort study.
The main study, reported by medwireNews, previously showed that receipt of metabolic surgery versus usual care is associated with a significant reduction in cardiovascular risk in this population, say Ali Aminian (Cleveland Clinic, Ohio, USA) and colleagues.
For the secondary analysis, the researchers compared the incidence of MACE – defined as first occurrence of all-cause mortality, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, or nephropathy – among 1362 individuals who underwent RYGB and 693 who underwent SG at the Cleveland Clinic in 1998–2017. Participants had a median BMI of approximately 45 kg/m2 and a median bodyweight of 126 kg prior to surgery.
During 5 years of follow-up, MACE occurred in 13.7% of people in the RYGB group, compared with 24.7% in the SG group, translating into a significant hazard ratio (HR) of 0.77 favoring RYGB after adjustment for factors including age, sex, baseline BMI, smoking, prior cardiometabolic disease, and glycemic control.
When the six components of MACE were analyzed separately, RYGB was associated with a significantly lower risk for nephropathy than SG (HR=0.47), which “supports other evidence showing that the risk of nephropathy is extremely sensitive to weight changes and diabetes control,” report Aminian and team. They found that rates of the other endpoints were numerically lower with RYGB versus SG, but the between-group differences did not reach statistical significance.
In line with the cardiovascular results, people in the RYGB group achieved a significant 9.7-percentage point greater weight loss and a significant 0.31% lower glycated hemoglobin level at 5 years relative to those in the SG group. Those given RYGB also had significantly lower rates of noninsulin diabetes medication, renin-angiotensin system blocker, lipid-lowering therapy, and aspirin use.
The “constellation of favorable weight loss–dependent and weight-independent changes” seen in this study and reported previously “may explain better diabetes control, less medication use, and reduced risk of MACE after RYGB,” write the researchers in Diabetes Care.
Despite these benefits, people in the RYGB group were significantly more likely than those in the SG group to require upper endoscopy (45.8 vs 35.6%) or abdominal surgical procedures (10.8 vs 5.4%) in the 5 years after metabolic surgery.
“Several factors should be considered when the patient and medical team make a shared decision about the most appropriate metabolic surgical procedure,” say Aminian and colleagues, noting that “SG may be a better choice in patients with higher surgical risk.”
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