Abstract
Introduction: Surgical treatment for obesity, a major risk factor for diabetes and cardiovascular disease, may lead to important improvements in cardiovascular health. Sleeve gastrectomy (SG) procedures have gained popularity over Roux-en-Y gastric bypass (RYGB), though it is unclear which procedure results in improved cardiovascular outcomes. Our objective was to evaluate the comparative cardiovascular safety of SG vs. RYGB in older patients with type 2 diabetes (T2D). Methods: Using Medicare claims data, we identified a cohort of T2D patients ≥65 years that underwent a SG or RYGB procedure between 2010 and 2018. Patients undergoing a SG were propensity-score (PS) matched 1:1 to RYGB patients on the propensity score of receiving the procedure. The two co-primary outcomes were a major adverse cardiovascular event (MACE, a composite of stroke, myocardial infarction (MI) or all-cause mortality) and hospitalization for heart failure (HHF). Secondary outcomes were the individual components of MACE. Subjects were followed until the occurrence of an outcome, end of patient data or enrollment or death, whichever came first. We estimated the hazard ratios (HR) for each outcome, adjusting for demographics, comorbidities, medication use and healthcare utilization using PS matching. Results: A total of 5,514 patients undergoing SG were PS-matched to 5,514 undergoing RYGB and followed for a median of 2.3 years (IQR: 1.2, 3.9) after the procedures. Compared to RYGB, patients undergoing SG had a similar risk of MACE (rate 2.5 vs. 3.0 per 100 person-years (py); HR: 0.94; 95% CI: 0.82, 1.09) and of HHF (rate 12.2 vs. 10.9 per 100 py; HR: 1.01; 95%CI: 0.94, 1.09). For secondary outcomes, the risk of MI was higher for SG (rate 0.8 vs. 0.7 per 100 py; HR: 1.33, 95%CI: 1.02, 1.75), whereas SG was associated with a lower risk of all-cause mortality (rate 1.5 vs. 2.2 per 100 py; HR: 0.68; 95%CI: 0.57, 0.81). Conclusions: In older patients with T2D, SG was associated with a similar risk of MACE and HHF compared to RYBG. However, when we assessed the individual components of MACE separately, SG was associated with a higher risk of MI and a lower risk of death, compared with RYBG.
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