Abstract
Objective: To determine whether early Roux-en-Y gastric bypass surgery (RYGB) reduces the risk of Major adverse cardiovascular events (MACE) in patients with obesity.Patients and Methods: We conducted a study of patients with class II and III obesity [body mass index (BMI) > 35 kg/m2] from Olmsted County, Minnesota, who underwent obesity clinic consultation between the years 1993–2012, and had either RYGB surgery within 1 year (RYGB-1Y group), or medically managed (No-RYGB group). The composite endpoint of MACE (all-cause mortality, stroke, heart failure admission and acute myocardial infarction) was the primary endpoint, with new-onset AF as the secondary endpoint.Results: Of the 1,009 study patients, 308 had RYGB-1Y and 701 were medically managed (No-RYGB). Overall, the age was 44.0 ± 12.4 (mean ± SD) years; BMI was 45.0 ± 6.8 kg/m2. The RYGB-1Y group had a lower rate of MACE (adjusted hazard ratio (HR), 0.62; 95% CI, 0.44–0.88; P = 0.008) and lower mortality (adjusted HR, 0.51; 95% CI, 0.26–0.96; P = 0.04) than the No-RYGB group. The RYGB-1Y surgery was not associated with lower AF occurrence (HR, 0.66; 95% CI, 0.40–1.10; P = 0.11).Conclusion: An early RYGB approach for BMI reduction was associated with lower rates of MACE.
Highlights
Obesity is a worldwide epidemic [1, 2], affecting more than one-third of adults in the United States [3]
The Roux-en-Y gastric bypass (RYGB)-1Y group had a lower rate of major adverse cardiovascular events (MACE) (adjusted hazard ratio (HR), 0.62; 95% CI, 0.44–0.88; P = 0.008) and lower mortality than the No-RYGB group
The RYGB-1Y surgery was not associated with lower atrial fibrillation (AF) occurrence (HR, 0.66; 95% CI, 0.40–1.10; P = 0.11)
Summary
Obesity is a worldwide epidemic [1, 2], affecting more than one-third of adults in the United States [3]. Bariatric Surgery and Cardiovascular Events as epidemic and is associated with multiple adverse sequelae, such as stroke, heart failure, dementia, diminished quality of life, and death [12]. Bariatric surgery is an effective approach in treating patients with morbid obesity, achieving long-lasting weight reduction and reducing concomitant comorbidities [13,14,15]. A prospective randomized study showed that the use of Roux-en-Y gastric bypass (RYGB) in morbidly obese patients was associated with higher rates of diabetes remission and lower risk of cardiovascular events over a period of 6 years compared with non-surgical control patients [16]. The objective of this study was to determine whether early RYGB surgery reduces the incidence of AF or of major adverse cardiovascular events (MACE) in obese patients compared to nonsurgical therapy (diet, exercise, and medication) or late RYGB surgery
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