Bariatric Surgery Reduces Hospitalization for Stable Angina

Study Questions:

Is bariatric surgery associated with lower rates of hospitalization for stable angina pectoris among obese adults?

Methods:

This was a self-controlled case series design, which included obese adults with stable angina pectoris who underwent bariatric surgery. Data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) were used to determine hospitalization rates for stable angina pectoris from three states, California, Florida, and Nebraska. Hospitalization for bariatric surgery between 2005 and 2011 was also identified. Rates of hospitalization for stable angina pectoris in the population prior to bariatric surgery were used as a reference. The primary outcome of hospitalization for stable angina pectoris after bariatric surgery was compared with rates observed prior to surgery.

Results:

A total of 953 patients with documented stable angina pectoris and who received bariatric surgery were included in the study population. The median age was 57 years, 51% were women, and 78% were non-Hispanic white. Prior to surgery, 25.3% (95% confidence interval [CI], 22.5-28.1%) were hospitalized for stable angina pectoris. The rate remained stable in the 12 months prior to surgery (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.69-1.02; p = 0.07). In the first 12-month period after bariatric surgery, a significantly lower rate of hospitalizations for stable angina pectoris (9.1%; 95% CI, 7.3-11.0%) compared to pre-surgery. The OR was 0.33 (95% CI, 0.26-0.43; p < 0.0001) using the presurgery rate as a reference. Similarly, the rate remained significantly lower in the subsequent 13–24 months after bariatric surgery (8.7%; 95% CI, 6.9-10.5%). Compared to the reference (prior to surgery), the OR was 0.31 (95% CI, 0.24-0.41; p < 0.0001).

Conclusions:

The investigators concluded that in this population-based study of obese adults with stable angina pectoris, the rate of hospitalizations for stable angina pectoris was lower by two-thirds after bariatric surgery.

Perspective:

This study suggests that benefits to weight loss with bariatric surgery include reductions in angina. As the authors point out, understanding the mechanism behind this benefit is warranted. In addition, a randomized controlled trial would add to the evidence presented, in particular, if medication management was similar between groups.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Stable Ischemic Heart Disease, Chronic Angina

Keywords: Angina, Stable, Bariatric Surgery, Health Care Costs, Hospitalization, Metabolic Syndrome X, Obesity, Primary Prevention, Surgical Procedures, Elective, Weight Loss


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