Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population

J Am Coll Cardiol. 2022 Apr 19;79(15):1429-1437. doi: 10.1016/j.jacc.2022.01.047.


Background: The long-term effect of bariatric surgery on cardiovascular outcomes in the elderly population is not well studied.

Objectives: The aim of this study was to evaluate the association between bariatric surgery and long-term cardiovascular outcomes in the Medicare population.

Methods: Medicare beneficiaries who underwent bariatric surgery from 2013 to 2019 were matched to a control group of patients with obesity with a 1:1 exact matching based on age, sex, body mass index, and propensity score matching on 87 clinical variables. The study outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. An instrumental variable analysis was performed as a sensitivity analysis.

Results: The study cohort included 189,770 patients (94,885 matched patients in each group). By study design, the 2 groups had similar age (mean: 62.33 ± 10.62 years), sex (70% female), and degree of obesity (mean body mass index: 44.7 ± 7.3 kg/m2) and were well balanced on all clinical variables. After a median follow-up of 4.0 years (IQR: 2.4-5.7 years), bariatric surgery was associated with a lower risk of mortality (9.2 vs 14.7 per 1,000 person-years; HR: 0.63; 95% CI: 0.60-0.66), new-onset HF (HR: 0.46; 95% CI: 0.44-0.49), MI (HR: 0.63; 95% CI: 0.59-0.68), and stroke (HR: 0.71; 95%: CI: 0.65-0.79) (P < 0.001). The benefit of bariatric surgery was evident in patients who were 65 years and older. Using instrumental variable analysis, bariatric surgery was associated with a lower risk of mortality, HF, and MI.

Conclusions: Among Medicare beneficiaries with obesity, bariatric surgery is associated with lower risk of mortality, new-onset HF, and MI.

Keywords: bariatric surgery; cardiovascular outcomes; obesity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bariatric Surgery*
  • Body Mass Index
  • Female
  • Heart Failure* / complications
  • Heart Failure* / epidemiology
  • Heart Failure* / surgery
  • Humans
  • Male
  • Medicare
  • Middle Aged
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / epidemiology
  • Myocardial Infarction* / surgery
  • Obesity / complications
  • Obesity / epidemiology
  • Obesity / surgery
  • Retrospective Studies
  • United States / epidemiology