Bariatric Surgery Beats GLP-1s for Heart Protection in T2D

 Among adults with obesity and type 2 diabetes (T2D), metabolic and bariatric surgery reduced the risk for major adverse cardiovascular events by more than 50% compared with GLP‑1 therapy.

METHODOLOGY: 

• Obesity and T2D greatly increase the risk for cardiovascular illness and death worldwide. Both metabolic and bariatric surgery and GLP-1s effectively manage these conditions. Direct comparisons of their effects on long-term major adverse cardiovascular events and all-cause mortality are lacking.
• Researchers conducted a systematic review and meta-analysis of 11 studies comprising 19,644 individuals with obesity and T2D from the United States, China, Italy, Sweden, Israel, Australia, and Taiwan.
• The included studies were a mix of randomized controlled trials (n = 4), propensity score-matched cohort studies (n = 3), and nationwide matched cohort studies (n = 4), comparing metabolic and bariatric surgery (predominantly Roux-en-Y gastric bypass and sleeve gastrectomy) with GLP-1 therapy (primarily liraglutide, semaglutide, and dulaglutide).
• The studies were required to have assessed outcomes such as all-cause mortality and major adverse cardiovascular events, including myocardial infarction, stroke, ischemic heart disease, and the need for coronary revascularization procedures.
• Follow-up periods ranged from 1 to 12 years.

TAKEAWAY: 

• A meta-analysis of 10 studies evaluating cardiovascular outcomes showed that metabolic and bariatric surgery was associated with a 52% reduction in the relative risk for major adverse cardiovascular events when compared with GLP-1 therapy (pooled relative risk [RR], 0.48; P < .001).
• A subgroup analysis by study design showed consistent cardiovascular benefit in randomized controlled trials (RR, 0.31; 95% CI, 0.14-0.72) and observational cohort studies (RR, 0.57; 95% CI, 0.38-0.84).
• Regional variation revealed the most pronounced risk reduction in studies from the United States (RR, 0.27; P < .001), Italy (RR, 0.08; P = .003), and Israel (RR, 0.41; P = .008).

IN PRACTICE:

"While both approaches offer substantial clinical benefit, MBS [metabolic and bariatric surgery] provides more pronounced and durable risk reduction, particularly in those with longstanding diabetes and elevated cardiovascular risk, albeit at the expense of greater perioperative and nutritional risk," the authors wrote.

SOURCE:

The study was led by Joshua Chadwick, MD, MPH, ICMR-National Institute of Epidemiology in Chennai, India. It was published online in Obesity Surgery.

LIMITATIONS: 

The included studies are predominantly observational, introducing potential confounding and bias despite adjustment for known risk factors. Heterogeneity in patient populations, intervention details, and outcome definitions may limit direct comparability across studies. Follow-up durations varied across studies.

DISCLOSURES:

No funding source was provided for conducting this study. The authors reported no competing interests.

https://www.medscape.com/viewarticle/bariatric-surgery-beats-glp-1s-heart-protection-t2d-2026a100069q