Effectiveness of bariatric metabolic surgery versus glucagon-like peptide-1 receptor agonists for prevention of congestive heart failure

May 15, 2024Nature medicine

How weight-loss surgery and diabetes drugs compare in preventing heart failure

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Abstract

In a cohort of 2,205 matched patients, 1.2% of those treated with bariatric metabolic surgery (BMS) developed congestive heart failure compared to 4.1% of those treated with glucagon-like peptide-1 receptor agonists (GLP-1RA).

Bariatric metabolic surgery (BMS) is associated with a lower primary incidence of congestive heart failure (CHF) compared to glucagon-like peptide-1 receptor agonists (GLP-1RA).
The adjusted hazard ratio for CHF incidence in patients treated with BMS versus GLP-1RA is 0.43, suggesting a significant difference between the two treatments.
Further adjustments for weight reduction did not significantly change the association, with a hazard ratio of 0.48 after controlling for this factor.
The study followed patients for a median of 6.6 years, providing insight into long-term cardiovascular outcomes related to these treatments.
Additional long-term comparative studies are needed as the use of newer, more potent GLP-1RAs increases.

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Comparative evidence for the effects of bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RA) on cardiovascular outcomes is limited. Here, in an observational, retrospective cohort study, we compared the incidence of congestive heart failure (CHF) in adults living with obesity and diabetes without history of CHF (primary CHF) treated with BMS versus GLP-1RA. The population cohort comprised members of Clalit Health Services with no prior history of ischemic heart disease, ischemic stroke or CHF. During the time period of 2008-2021, patients who underwent their first BMS were matched 1:1 with patients who initiated treatment with GLP-1RA, based on clinical characteristics. The study included 2,205 matched pairs of patients (64.5% female), followed for a median of 6.6 years and up to 12 years. Primary incidence of CHF occurred in 26 (1.2%) patients treated with BMS and in 90 patients treated with GLP-1RA (4.1%) (adjusted hazard ratio 0.43, 95% confidence interval 0.27-0.68). Further adjustment for weight reduction did not significantly diminish this association (hazard ratio adjusted for weight reduction 0.48, 95% confidence interval 0.28-0.82), indicating that the differential effect was not mediated through the relative advantage of BMS in maximal weight reduction. In this study, BMS was associated with a stronger reduction in primary incidence of CHF compared with treatment with GLP-1RA. With the increasing use of highly potent next-generation GLP-1RAs, further comparative long-term studies are warranted.

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Effectiveness of bariatric metabolic surgery versus glucagon-like peptide-1 receptor agonists for prevention of congestive heart failure

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