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Macrovascular complications

Surgery significantly reduces long-term macrovascular complications

Patients in the bariatric surgery group, compared to the conventional treatment group, had lower incidence of macrovascular complications, cardiovascular events and myocardial infarction

Bariatric surgery could significantly reduce long-term macrovascular complications along with greater weight loss and better intermediate glucose outcomes among patients with severe obesity and T2DM patients, compared to patients receiving only conservative medical measures, according to a research team led by Henan University of Chinese Medicine, Zhengzhou, China.

The paper, 'Long-term outcomes of macrovascular diseases and metabolic indicators of bariatric surgery for severe obesity type 2 diabetes patients with a meta-analysis', published in PLOSOne, sought to provide evidence on the risks of macrovascular diseases, including coronary artery disease and cerebrovascular disease, and separately myocardial infarction (MI) and stroke, and the physiological and biochemical metabolic indicators following bariatric surgery with comparison to non-surgical treatments in severely obese patients with T2DM of follow-up for more than five years.

The researchers performed a systematic literature review of randomised clinical trials (RCTs) or cohort studies that compared bariatric surgery and conventional medical therapy for long-term incidence of macrovascular events and metabolic outcomes in severely obese patients with T2DM. Four RCTs and six cohort studies were involved in the final review (Table 1).

Of the ten studies:

  • Three studies followed up for five years (involving 282 patients)
  • Two studies followed up for six years (involving 32499 patients)
  • One study followed up for ten years (involving 50 patients)
  • One study followed up for 11 years (involving 158 patients)
  • One study followed up for 14 years (involving 15951 patients)
  • One study followed up for 15 years (involving 603 patients); and
  • One study followed up for 20 years (involving 607 patients)

Table 1. Baseline characteristics of the included studies

The authors found that bariatric surgery patients had a lower incidence of macrovascular complications (RR = 0.43, 95% CI=0.27~0.70), cardiovascular events (CVEs) (HR=0.52, 95% CI=0.39~0.71), and MI (RR=0.40, 95% CI=0.26~0.61), compared to the conventional medical group. In addition, bariatric surgery was also associated with better weight and better glycaemic control over the long-term vs. non-surgical therapies and different surgical methods had different effects on various metabolic indicators.

“Given the lack of evidence on the long-term benefit of bariatric surgery for severely obese patients with type 2 diabetes, there is an urgent need for an assessment of this issue,” the authors cautioned. “This meta-analysis evaluated the long-term effects of different types of bariatric surgery on prognostic indicators and for MI and stroke incidence in T2DM. It was found that the different surgical methods have different effects on metabolic indicators.”

To access this paper, please click here

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