The long-term cardiovascular benefits of metabolic and bariatric surgery versus pharmacological therapies in patients with type 2 diabetes and obesity: a systematic review and meta-analysis.
Junle Tong, Yaoquan Cao, Yu Han et al.
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In 30 seconds
This systematic review and meta-analysis compared metabolic and bariatric surgery (MBS) with pharmacological therapies in patients with type 2 diabetes and obesity, including 15 controlled studies. MBS was associated with fewer major adverse cardiovascular events (MACE), with the advantage remaining significant at 5 years (odds ratio 0.66, 95% confidence interval 0.59 to 0.73) and increasing over time. Improvements in cardiovascular risk factors varied by follow-up period: surgery showed greater changes in different measures of glycaemia, lipids, and blood pressure across the reported intervals.
Key findings
- MBS was associated with lower MACE at 5 years than pharmacological therapies (odds ratio 0.66, 95% confidence interval 0.59 to 0.73).
- The reported MACE advantage of MBS continued to increase over time.
- MBS showed greater improvement in HbA1c, total cholesterol, and LDL-C at 0-1 year; triglycerides and HDL-C at 0-2 years; and systolic and diastolic blood pressure at 2-5 years.
- MBS showed greater improvement in fasting blood glucose over 0-5 years.
Why it matters
Cardiovascular risk in people with type 2 diabetes and obesity is influenced by multiple metabolic factors. This comparison suggests that MBS may offer sustained cardiovascular benefit relative to pharmacological therapies, while the relative changes in individual risk factors depend on follow-up duration. These findings help frame the evidence for comparing treatment approaches, but do not establish that surgery is preferable for every patient.
What to keep in mind
The abstract does not report study-level design details or the number of participants, limiting assessment of the evidence base and comparability of included studies.