JAMA Surg

Gastric bypass surgery associated with lower long-term CV risk

May 13, 2025

Study details: This population-based, inverse probability-weighted cohort study analyzed administrative claims data from Switzerland, including 39,067 adults (median age, 42 years; 61% with BMI ≥40) who underwent gastric bypass (77.5%) or sleeve gastrectomy (22.5%) between January 2012 and December 2022. The primary outcome was the incidence of 4-point major adverse cardiac events (MACE), including acute MI, ischemic stroke, hospitalizations for heart failure, and all-cause mortality, with a median follow-up of 5.1 years. Secondary outcomes were the individual components of MACE, surgical re-interventions, and associated complications.

Results: MACE incidence was significantly lower in the gastric bypass group (1.9%) compared with the sleeve gastrectomy group (3.0%), with incidence rates of 3.96 and 5.10 per 1,000 patient-years, respectively (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.64-0.88). This reduction was primarily driven by a lower rate of acute MI (HR, 0.63; 95% CI, 0.46-0.86). No significant differences were observed in ischemic stroke, hospitalization for heart failure, or all-cause mortality. Secondary outcomes also favored gastric bypass, except for higher rates of revision surgery and immediate postoperative complications.

Clinical impact: Gastric bypass surgery is associated with a lower risk of MACE compared with sleeve gastrectomy, particularly in reducing the incidence of acute MI. However, the increased risk of revision surgery and immediate postoperative complications should be considered when selecting the appropriate bariatric procedure for patients.

Source:

Wildisen S, et al. (2025, May 7). JAMA Surg. Major Adverse Cardiac Events After Gastric Bypass vs Sleeve Gastrectomy. https://pubmed.ncbi.nlm.nih.gov/40332926/