Major Adverse Cardiovascular Events Among Obese Patients with Diabetes After Metabolic and Bariatric Surgery: a Meta-analysis of Matched Cohort and Prospective Controlled Studies with 122,361 Participates

Overview

Journal Obes Surg

Date 2023 May 15

PMID 37184826

Authors

Wenxing Yang

Mengjun Zhan

Zhuo Li

Xuehong Sun

Kui Zhang

Affiliations

Soon will be listed here.

Abstract

Purpose: Metabolic and bariatric surgery (MBS) can exert effective function on glycemic control. The present study aimed to estimate the risk of MACE among obese patients with diabetes after MBS.

Materials And Methods: Systematic search of PubMed, Embase, Medline, and Web of Science was performed for studies published before 20th February 2023. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to assess the outcome. The statistical heterogeneity among studies was assessed with the Q-test and I statistics.

Results: Fifteen cohort studies with 122,361 obese patients with diabetes were available for analysis. Our meta-analysis found significantly decreased morbidity and mortality of MACE (OR = 0.65, 95% CI = 0.59-0.72, I = 62.8% for morbidity, OR = 0.49, 95% CI = 0.36-0.67, I = 68.7% for mortality). Subgroup analysis revealed MBS decreased cerebrovascular disease, coronary artery disease, atrial fibrillation, heart failure, myocardial infarction, and stroke risk.

Conclusion: Our meta-analysis indicated that MBS for obese patients with diabetes is beneficial to decreasing MACE risk. Moreover, further studies estimating the functional effect may eventually provide a better and comprehensive understanding of the effect on different populations.

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References

Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393-403. PMC: 1370926. DOI: 10.1056/NEJMoa012512. View

Zheng Y, Ley S, Hu F . Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2017; 14(2):88-98. DOI: 10.1038/nrendo.2017.151. View

Afshin A, Forouzanfar M, Reitsma M, Sur P, Estep K, Lee A . Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017; 377(1):13-27. PMC: 5477817. DOI: 10.1056/NEJMoa1614362. View

Kahn S, Hull R, Utzschneider K . Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006; 444(7121):840-6. DOI: 10.1038/nature05482. View

Sandouk Z, Lansang M . Diabetes with obesity--Is there an ideal diet?. Cleve Clin J Med. 2017; 84(7 Suppl 1):S4-S14. DOI: 10.3949/ccjm.84.s1.02. View

Booth H, Khan O, Prevost T, Reddy M, Dregan A, Charlton J . Incidence of type 2 diabetes after bariatric surgery: population-based matched cohort study. Lancet Diabetes Endocrinol. 2014; 2(12):963-8. DOI: 10.1016/S2213-8587(14)70214-1. View

Garvey W, Ryan D, Henry R, Bohannon N, Toplak H, Schwiers M . Prevention of type 2 diabetes in subjects with prediabetes and metabolic syndrome treated with phentermine and topiramate extended release. Diabetes Care. 2013; 37(4):912-21. PMC: 4392900. DOI: 10.2337/dc13-1518. View

Davies M, Bergenstal R, Bode B, Kushner R, Lewin A, Skjoth T . Efficacy of Liraglutide for Weight Loss Among Patients With Type 2 Diabetes: The SCALE Diabetes Randomized Clinical Trial. JAMA. 2015; 314(7):687-99. DOI: 10.1001/jama.2015.9676. View

Rubino F, Nathan D, Eckel R, Schauer P, Alberti K, Zimmet P . Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care. 2016; 39(6):861-77. DOI: 10.2337/dc16-0236. View

10.

Strain W, Paldanius P . Diabetes, cardiovascular disease and the microcirculation. Cardiovasc Diabetol. 2018; 17(1):57. PMC: 5905152. DOI: 10.1186/s12933-018-0703-2. View

11.

Ritchie R, Abel E . Basic Mechanisms of Diabetic Heart Disease. Circ Res. 2020; 126(11):1501-1525. PMC: 7251974. DOI: 10.1161/CIRCRESAHA.120.315913. View

12.

Curioni C, Lourenco P . Long-term weight loss after diet and exercise: a systematic review. Int J Obes (Lond). 2005; 29(10):1168-74. DOI: 10.1038/sj.ijo.0803015. View

13.

Anderson J, Konz E, Frederich R, Wood C . Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001; 74(5):579-84. DOI: 10.1093/ajcn/74.5.579. View

14.

Eisenberg D, Shikora S, Aarts E, Aminian A, Angrisani L, Cohen R . 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022; 18(12):1345-1356. DOI: 10.1016/j.soard.2022.08.013. View

15.

Keating C, Neovius M, Sjoholm K, Peltonen M, Narbro K, Eriksson J . Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study. Lancet Diabetes Endocrinol. 2015; 3(11):855-65. PMC: 4880549. DOI: 10.1016/S2213-8587(15)00290-9. View

16.

Papasavas P, Gagne D, Kelly J, Caushaj P . Laparoscopic Roux-En-Y gastric bypass is a safe and effective operation for the treatment of morbid obesity in patients older than 55 years. Obes Surg. 2004; 14(8):1056-61. DOI: 10.1381/0960892041975541. View

17.

Lynch J, Belgaumkar A . Bariatric surgery is effective and safe in patients over 55: a systematic review and meta-analysis. Obes Surg. 2012; 22(9):1507-16. DOI: 10.1007/s11695-012-0693-1. View

18.

Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I . Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007; 142(4):621-32. DOI: 10.1016/j.surg.2007.07.018. View

19.

OBrien P, McPhail T, Chaston T, Dixon J . Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006; 16(8):1032-40. DOI: 10.1381/096089206778026316. View

20.

Buchwald H, Estok R, Fahrbach K, Banel D, Jensen M, Pories W . Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009; 122(3):248-256.e5. DOI: 10.1016/j.amjmed.2008.09.041. View