Key result
Metabolic surgery was associated with a reduced risk for MACE in patients with preexisting heart disease and T2D (HR 0.59; 95% CI 0.48-0.72; P<0.001) and without T2D (HR 0.73; 95% CI 0.57-0.94).
Why the study?
It was unknown whether the cardiovascular benefits of metabolic surgery in patients with established heart disease are influenced by type 2 diabetes status.
Does metabolic surgery reduce major cardiovascular events or mortality in patients with established heart disease with or without type 2 diabetes?
Cohort (n=3,026)
Yes
Does metabolic surgery reduce major cardiovascular events or mortality in patients with established heart disease with or without type 2 diabetes?
Hazard Ratio: 0.59 (95% CI 0.48–0.72)
p-value: p=<.001
Metabolic surgery is associated with a significantly reduced risk of MACE and mortality in patients with preexisting heart disease, with the greatest risk reduction observed in those who also have type 2 diabetes.
Metabolic surgery may lower MACE and mortality risk in heart disease patients regardless of T2D; leaves open whether T2D status modifies benefit in trials.
BACKGROUND: While metabolic surgery is known to improve type 2 diabetes (T2D) as well as established heart disease separately, it is not known whether the outcome is influenced by T2D status in patients with established heart disease. OBJECTIVES: To evaluate the risks for major cardiovascular events (MACE) or mortality in patients with established heart disease with or without T2D. SETTING: Nationwide and registry-based (Sweden). METHODS: Patients with established heart disease operated with sleeve gastrectomy or Roux-en-Y gastric bypass in Sweden from 2007-2019 were matched 1:1 to normal population controls using 2-staged matching (exact matching on T2D, followed by optimal matching on propensity score for age, sex, dyslipidemia, chronic obstructive pulmonary disease, type of heart disease, T2D duration, county of residence, and level of education). The risk for MACE was evaluated separately depending on T2D status. RESULTS: In total, 1513 patients who underwent surgery and 1513 matched controls were included. Reduced risk for MACE and mortality were seen after metabolic surgery for patients with heart disease and T2D compared with controls (adjusted hazard ratio [HR] = .59, 95% confidence interval [CI]: .48-.72, P < .001, and adjusted HR = .52, 95% CI: .40-.67, P < .001, respectively), and for patients with heart disease alone compared with controls (adjusted HR = .73, 95% CI: .57-.94, P = .016, and adjusted HR = .63, 95% CI: .45-.89, P = .008, respectively). CONCLUSION: Metabolic surgery was associated with a reduced risk for MACE and mortality in patients with preexisting heart disease and T2D as well as in patients with heart disease without T2D. Patients with heart disease and T2D seem to experience the highest risk reduction.
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Stenberg et al. (2022) conducted a cohort in Established heart disease with or without type 2 diabetes (n=3,026). Metabolic surgery vs. Matched normal population controls was evaluated on Major cardiovascular events (MACE) in patients with heart disease and T2D (HR 0.59, 95% CI 0.48-0.72, p=<.001). Metabolic surgery was associated with a reduced risk for MACE in patients with preexisting heart disease and T2D (HR 0.59; 95% CI 0.48-0.72; P<0.001) and without T2D (HR 0.73; 95% CI 0.57-0.94).
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