Key result
Early Roux-en-Y gastric bypass surgery reduced the risk of major adverse cardiovascular events by 38% (HR 0.62) compared to medical management in patients with class II and III obesity.
Why the study?
To determine whether early Roux-en-Y gastric bypass surgery reduces the risk of major adverse cardiovascular events in patients with obesity.
Does early Roux-en-Y gastric bypass surgery reduce new-onset atrial fibrillation and major adverse cardiovascular events in patients with class II and III obesity?
Cohort (n=1,009)
No
Does early Roux-en-Y gastric bypass surgery reduce new-onset atrial fibrillation and major adverse cardiovascular events in patients with class II and III obesity?
Hazard Ratio: 0.62 (95% CI 0.44–0.88)
p-value: p=0.008
Early bariatric surgery in patients with class II and III obesity significantly reduces the risk of major adverse cardiovascular events and mortality, though it did not significantly reduce the incidence of atrial fibrillation in this cohort.
May inform bariatric referral decisions in class II-III obesity; extends observational data but leaves causality open.
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/m 2 ] 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/m 2 . 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.
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Yuan et al. (2021) conducted a cohort in Class II and III obesity (n=1,009). Early Roux-en-Y gastric bypass surgery (within 1 year) vs. Medical management or late bariatric surgery was evaluated on Major adverse cardiovascular events (MACE), a composite of all-cause mortality, stroke, heart failure admission, and acute myocardial infarction (HR 0.62, 95% CI 0.44-0.88, p=0.008). Early Roux-en-Y gastric bypass surgery reduced the risk of major adverse cardiovascular events by 38% (HR 0.62) compared to medical management in patients with class II and III obesity.
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