Review of Bariatric Surgery and Cardiovascular Disease

Quick Takes

  • Bariatric surgery among obese adults is associated with lower rates of all-cause and CV mortality.
  • Rates of MI, HF, and stroke were also lower.
  • Rates of AF were not statistically different between those receiving bariatric surgery and age, sex, and BMI matched controls.

Study Questions:

Does bariatric surgery to treat obesity improve cardiovascular (CV) outcomes?


This is a systematic review and meta-analysis of identified studies using searches of PubMed and Embase through August 2021. Eligible studies compared bariatric surgery patients to nonsurgical controls, which were matched on age, sex, and body mass index (BMI). CV outcomes included all-cause and CV mortality, atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), and stroke.


The search identified 2,965 publications, of which a total of 39 studies met the eligibility criteria. The included studies were all cohort studies, either prospective or retrospective. No randomized trials were identified. Bariatric surgery was associated with a beneficial effect on all-cause mortality (pooled hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.49–0.62; p < 0.001 vs. controls), and CV mortality (HR, 0.59; 95% CI, 0.47–0.73; p < 0.001). Bariatric surgery was also associated with a reduced incidence of HF (HR, 0.50; 95% CI, 0.38–0.66; p < 0.001), MI (HR, 0.58; 95% CI, 0.43–0.76; p < 0.001), and stroke (HR, 0.64; 95% CI, 0.53–0.77; p < 0.001). The association with AF was not statistically significant (HR, 0.82; 95% CI, 0.64–1.06; p = 0.12).


The authors concluded that the present systematic review and meta-analysis suggests that bariatric surgery is associated with reduced all-cause and CV mortality, and lowered incidence of HF, MI, and stroke among patients with obesity.


This systematic review and meta-analysis supports prior reviews suggesting that bariatric surgery is associated with improvements in CV outcomes. It should be noted that the studies included are not randomized controlled trials. In addition, studies to understand this association in multi-racial and ethnic populations are warranted.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Atrial Fibrillation, Bariatric Surgery, Body Mass Index, Cardiovascular Diseases, Heart Disease Risk Factors, Heart Failure, Metabolic Syndrome, Myocardial Infarction, Obesity, Primary Prevention, Stroke, Elective Surgical Procedures

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