The Relationship Between HF and Bariatric Surgery in Patients With Obesity

Patients who are obese and receive bariatric surgery have a lower rate of heart failure (HF) and all-cause mortality compared with patients who do not receive bariatric surgery, according to study findings published in the International Journal of Cardiology.

Investigators sought to compare the incidence of HF in patients with obesity who received bariatric surgery with those that received nonsurgical management. The primary outcome was the development of new HF. Secondary outcomes were hospitalizations due to HF and all-cause mortality.

They conducted a nationwide propensity-score matched retrospective cohort study using patient records from the Clinical Practice Research Database (CPRD), a nationwide UK database of primary care patient records integrated with secondary care data. The CPRD database contains primary care records of more than 19 million patients gathered from 945 general practice surgeries since 1987.

Patients included in the study were aged 18 years or older, had a BMI greater than 35, and no prior diagnosis of HF. Of 146,938 eligible patients, 3111 received bariatric surgery. Of these patients, 59 could not be matched.

Overall, 3052 patients who received bariatric surgery were propensity-score matched with 3052 patients who did not. Patients that received bariatric surgery had a mean age of 44.24 (SD, 10.84), 22.2% were men, and their mean BMI was 42.87 (SD, 6.30).  In the bariatric surgery cohort, 27.6% of patients had hypertension, 23.4% had type 2 diabetes mellitus, and 6.4% had hypercholesterolemia. In the same cohort, 47.8% smoked cigarettes, 1.4% drank alcohol, 24.3% were taking angiotensin-converting enzyme inhibitors, and 19.1% were taking beta-blockers. Duration of mean follow-up was 7.5 years (4.54 years bariatric surgery group; 10.45 years nonbariatric surgery group).

There was a significantly lower incidence of new HF among patients who received bariatric surgery vs those who did not (hazard ratio [HR], 0.45; 95% CI, 0.28-0.73; P =.0011). During follow-up there were 21 HF events in the bariatric surgery cohort and 147 in the nonbariatric surgery cohort.

There was a significantly lower incidence of all-cause mortality among patients who received bariatric surgery vs those who did not (HR, 0.56; 95% CI, 0.38-0.83; P =.0036). There were 33 deaths in the bariatric surgery cohort during follow-up vs 257 deaths in the nonbariatric surgery cohort. In the bariatric surgery cohort, 9.5% of patients that developed HF died compared with 41.5% of patients who developed HF in the nonbariatric surgery cohort.

Study limitations include the possibility of missing data and potential confounding.

 “….our study provides incremental evidence that bariatric surgery is associated with a reduced incidence of heart failure in patients with obesity, in a large nationwide propensity-score matched cohort,” the study authors wrote. “Taken with the wealth of other literature on the potential benefits of bariatric surgery in such patients, we suggest that bariatric surgery represents a crucial weapon in the fight against obesity—and, more widely, the metabolic syndrome.”

This article originally appeared on The Cardiology Advisor