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Estimating the Effect of Bariatric Surgery on Cardiovascular Events Using Observational Data?
- Source :
-
Epidemiology (Cambridge, Mass.) [Epidemiology] 2024 Sep 01; Vol. 35 (5), pp. 721-729. Date of Electronic Publication: 2024 Jul 18. - Publication Year :
- 2024
-
Abstract
- Background: Observational studies have reported strongly protective effects of bariatric surgery on cardiovascular disease, but with oversimplified definitions of the intervention, eligibility criteria, and follow-up, which deviate from those in a randomized trial. We describe an attempt to estimate the effect of bariatric surgery on cardiovascular disease without introducing these sources of bias, which may not be entirely possible with existing observational data.<br />Methods: We propose two target trials among persons with diabetes: (1) bariatric operation (vs. no operation) among individuals who have undergone preoperative preparation (lifestyle modifications and screening) and (2) preoperative preparation and a bariatric operation (vs. neither preoperative nor operative component). We emulated both target trials using observational data of US veterans.<br />Results: Comparing bariatric surgery with no surgery (target trial #1; 8,087 individuals), the 7-year cardiovascular risk was 18.0% (95% CI = 6.9, 32.7) in the surgery group and 18.9% (95% CI = 17.7, 20.1) in the no-surgery group (risk difference -0.9, 95% CI = -12.0, 14.0). Comparing preoperative components plus surgery vs. neither (target trial #2; 10,065 individuals), the 7-year cardiovascular risk was 17.4% (95% CI = 13.6, 22.0) in the surgery group and 18.8% (95% CI = 17.8, 19.9) in the no-surgery group (risk difference -1.4, 95% CI = -5.1, 3.2). Body mass index and hemoglobin A1c were reduced with bariatric interventions in both emulations.<br />Conclusions: Within limitations of available observational data, our estimates do not provide evidence that bariatric surgery reduces cardiovascular disease and support equipoise for a randomized trial of bariatric surgery for cardiovascular disease prevention.<br />Competing Interests: The authors report no conflicts of interest.<br /> (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Humans
Female
Middle Aged
Male
Observational Studies as Topic
United States epidemiology
Adult
Veterans statistics & numerical data
Diabetes Mellitus, Type 2 epidemiology
Bariatric Surgery statistics & numerical data
Cardiovascular Diseases epidemiology
Cardiovascular Diseases prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1531-5487
- Volume :
- 35
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Epidemiology (Cambridge, Mass.)
- Publication Type :
- Academic Journal
- Accession number :
- 39024034
- Full Text :
- https://doi.org/10.1097/EDE.0000000000001765