Key result
Bariatric surgery cuts MACE ~34% vs control and outperforms GLP-1 receptor agonists.
Why the study?
Obesity increases cardiovascular risk, but comparative cardiovascular efficacy of bariatric surgery versus GLP-1 receptor agonists in obesity was not established.
Does bariatric surgery or GLP-1RAs reduce major adverse cardiovascular events, heart failure, and myocardial infarction in adults with obesity and cardiovascular risk factors?
Systematic Review (n=932,380)
Does bariatric surgery or GLP-1RAs reduce major adverse cardiovascular events, heart failure, and myocardial infarction in adults with obesity and cardiovascular risk factors?
Bariatric surgery demonstrated more consistent and substantial reductions in cardiovascular outcomes compared to GLP-1RAs in patients with obesity, though GLP-1RAs remain an effective evidence-based alternative for non-surgical candidates.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Surgery vs GLP-1 for the heart: the first network meta-analysis to rank both against the same control. Shirmohammadi, Ghasemloo … Fardoost (Endocrinol Diabetes Metab, Sep 2026; 9(5):e70311; DOI 10.1002/edm2.70311): 43 studies, 932,380 people with obesity, searched to Sep 2024. Random-effects HRs vs control: • Bariatric surgery: MACE 0.66, heart failure 0.45, MI 0.53 • GLP-1RAs: MACE 0.85; heart failure and MI not significant. Surgeon read: a strong signal, not a head-to-head verdict. The surgical arm is almost all observational cohorts, the drug arm almost all RCTs of earlier GLP-1RAs (not tirzepatide), and heterogeneity ran to I² 66–93%. The real gap is a randomised trial of surgery vs modern incretins for hard cardiac outcomes. Not patient advice.”
“Cost is one axis. Hard cardiac outcomes are another. New network meta-analysis (Shirmohammadi et al., Endocrinol Diabetes Metab, Sep 2026; DOI 10.1002/edm2.70311): 43 studies, 932,380 people with obesity. Vs control, bariatric surgery HR 0.66 for MACE and 0.45 for heart failure; GLP-1RAs 0.85 for MACE, heart failure not significant. Surgical data mostly observational, so a trial is still owed.”
Bariatric surgery should be prioritized over GLP-1RAs for MACE reduction in eligible obese patients; extends network meta-analysis evidence favoring surgery.
Background Obesity, a major global health issue, heightens the risk of cardiovascular diseases, including major adverse cardiovascular events (MACE), heart failure (HF) and myocardial infarction (MI). This study provides the first network meta‐analysis (NMA) integrating direct and indirect evidence to compare the cardiovascular efficacy of bariatric surgery (BS) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) in individuals with obesity. Methods A systematic review and NMA were performed in adherence to PRISMA guidelines. PubMed, Embase, Cochrane Library and Google Scholar were searched for studies published from January 2000 to September 2024. Eligible studies reported cardiovascular outcomes, specifically MACEs, HF and MI, in patients with obesity receiving BS, GLP‐1RAs or control treatment. Fixed‐ and random‐effects models were used to analyse hazard ratios (HRs) and risk ratios (RRs), with heterogeneity assessed with I 2 and consistency through node‐splitting analysis. Results Forty‐three studies involving 932,380 patients were included BS was associated with significantly greater reductions in MACEs (HR 0.66; 95% CI 0.60–0.74), HF (HR 0.45; 95% CI 0.38–0.53) and MI (HR 0.53; 95% CI 0.45–0.63) compared with controls in random‐effects models. GLP‐1RAs reduced MACEs (HR 0.85; 95% CI 0.77–0.94) but showed non‐significant effects on HF and MI. Despite high heterogeneity ( I 2 : 66%–93%), directional consistency was observed across studies. Conclusions BS demonstrated more consistent and statistically significant reductions in all cardiovascular outcomes compared to GLP‐1RAs, which showed more variable efficacy, particularly for HF and MI. Nevertheless, GLP‐1RAs remain effective evidence‐based alternatives for cardiovascular risk reduction in patients who are not candidates for surgery, but future studies on newer GLP‐1RAs are required. The high heterogeneity across studies highlights the need for cautious interpretation. These results may inform individualized treatment selection in patients with obesity at high cardiovascular risk.
Shirmohammadi et al. (2026) conducted a systematic review in Obesity with associated cardiovascular risk factors (n=932,380). Bariatric surgery vs. Control was evaluated on Major adverse cardiovascular events (MACEs) (HR 0.66, 95% CI 0.60-0.74, p=<0.001). Bariatric surgery significantly reduced the risk of major adverse cardiovascular events by 34% (HR 0.66) compared to control, demonstrating superior cardiovascular efficacy over GLP-1 receptor agonists.
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