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Surgical Obesity Treatment and Risk of Heart Failure
Study Questions:
Does surgical weight loss reduce the risk of heart failure (HF)?
Methods:
A retrospective analysis of the SOS (Swedish Obese Subjects) study, an ongoing prospective controlled study comparing the effects of weight loss by bariatric surgery and conventional management, was performed. A total of 4,047 patients were enrolled in SOS between September 1, 1987 and January 31, 2001. The incidence of HF was compared between patients who underwent bariatric surgery and those who received usual care (controls). A matching algorithm selected controls such that the current mean values of the matching variables in the control group moved as much as possible in the direction of the current mean values in the surgery group. Subjects eligible for the SOS study were between 37 and 60 years of age and had a body mass index (BMI) of ≥34 kg/m2 for men and ≥38 kg/m2 for women. Patients with prior history of HF were excluded.
Results:
Of the 4,047 participants enrolled in SOS, 2,003 underwent bariatric surgery and 2,030 received usual care (controls); 14 were excluded due to prior HF. Bariatric surgery lowered BMI by 25% at 1 year and by 16% at 15 years, while the BMI remained unchanged in the control group. During a median follow-up of 22 years, incident HF occurred in 188 patients in the surgery group and 266 patients in the control group, resulting in 35% lower risk of incident HF in the surgery group (95% confidence interval [CI], 0.54–0.79; p < 0.001). After adjustment, the cumulative incidence rates of HF were lower in the surgery group compared with the control group at 10, 15, and 20 years, 1.3%, 3.1%, and 5.8%, compared to 2.0%, 4.7%, and 8.7%, respectively. In the pooled population, the risk of HF declined across quartiles of increasing weight loss. The largest reduction in risk occurred in the quartile with the greatest weight loss after 1 year (mean -41 kg) (subhazard ratio, 0.51; 95% CI, 0.30–0.70; p < 0.001). This association remained statistically significant after adjustment for surgical intervention and after further adjustment for potential baseline confounders.
Conclusions:
When compared to usual care, weight loss with bariatric surgery was associated with reduced risk of incident HF among patients treated for obesity. Greater degrees of weight loss were associated with greater reductions in risk of HF.
Perspective:
Obesity is highly prevalent in Europe and in the United States and is associated with increased risk of HF. Weight reduction with bariatric surgery appears to significantly reduce the incidence of HF and could potentially modify cardiovascular risk factors as well as cardiovascular morbidity and mortality.
Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure
Keywords: Bariatric Surgery, Body Mass Index, Heart Failure, Metabolic Syndrome, Obesity, Primary Prevention, Risk Factors, Risk Reduction Behavior, Surgical Procedures, Operative, Weight Gain, Weight Loss
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