ESC 2019 — T2D+high BMI: metabolic surgery bests nonsurgical management for MACE reduction


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • Metabolic surgery for patients with obesity and type 2 diabetes (T2D) yields significant risk reductions vs nonsurgical management in terms of major adverse cardiovascular (CV) event (MACE) reductions. 

Why this matters

  • Editorial notes “imprecise matching” between surgery and nonsurgery groups and says such differences could have biased findings toward surgery, necessitating cautious interpretation.
  • Editorial asks, “In 2019, what is the best treatment option” for patients with obesity and diabetes? 
    • Answers that surgery might be preferred for motivated patients who cannot lose weight otherwise.

Results

  • Cumulative MACE rates:
    • 30.8% (95% CI, 27.6%-34.0%) with surgery vs 47.7% (46.1%-49.2%) without.
    • Absolute 8-year risk difference: 16.9% (13.1%-20.4%).
    • Adjusted HR: 0.61 (0.55-0.69).
  • Cumulative all-cause mortality at 8 years:
    • ​​​​​10.0% (95% CI, 7.8%-12.2%) with surgery vs 17.8% (16.6%-19.0%) without.
    • Absolute 8-year risk difference: 7.8% (5.1%-10.2%).
    • Adjusted HR: 0.59 (0.48-0.72).

Study design

  • Retrospective cohort study, Cleveland Clinic Health System,1998-2017; 2287 patients having metabolic surgery were matched 5:1 to patients (n=11,435) with obesity and diabetes having nonsurgical management. 
  • Primary outcome: first MACE occurrence (all-cause mortality, coronary artery events, cerebrovascular events, heart failure, nephropathy, Afib).
  • Funding: Medtronic.

Limitations

  • Observational, causation not established, some relevant differences between surgery and nonsurgery cohorts.

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