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Bariatric Surgery May Reduce Stroke Risk in Obese Patients


After bariatric surgery, risk of a cerebrovascular event among obese patients was found to be signficantly lower than among matched controls. An AHA 2019 preview.

Patients with obesity who undergo bariatric surgery are less likely to experience a cerebrovascular event than matched controls.

This finding is the result of preliminary research that will be presented at the American Heart Association’s Scientific Sessions 2019, November 16-18, in Philadelphia. (Oral Presentation 335)

The metabolic derangements associated with obesity are known to contribute to the development of cerebrovascular disease. However, while bariatric surgery is associated with improvements in weight and metabolic profiles, authors of the new study note that its effectiveness on long-term reduction of stroke risk has not been investigated. 

This is the largest and longest study of bariatric surgery to-date. Researchers, co-lead by Maddalena Ardissino, MBBS, BSc, academic foundation doctor at the Imperial College London in the United Kingdom, compared health records of more than 4200 patients who had bariatric surgery to an equal number of control patients who did not have surgery, matched by age, gender, and weight-for-height. 

Primary composite endpoint: occurrence of any major adverse cerebrovascular event (MACE, ie, intracranial hemorrhage, ischemic stroke, transient ischemic event, and subarachnoid hemorrhage). Secondary endpoints: composite ischemic events, hemorrhagic events, individual components of the primary endpoint and all-cause mortality. Mean follow-up was 11.4 years.


Analysis was by adjusted Cox proportional hazards model.
The primary endpoint of MACE occurred in 73 patients
Patients in the bariatric surgery group had significantly lower adjusted major cerebrovascular event rates (HR 0.352, 95%CI 0.195-0.637).
Authors note the lower rate was driven by reduced risk of ischemic events (HR 0.315, 95%CI 0.156-0.635) but not of hemorrhagic events (HR 0.442, 95%CI 0.147-1.330).
Overall all-cause mortality was lower in the bariatric surgery group (229 patients died during follow-up).

“These findings call for increased awareness and implementation of bariatric surgery as a treatment step for obese patients who are unable to achieve adequate weight loss through lifestyle and medication therapy,” said Ardissino, quoted in an AHA press release. “Currently, only a small fraction of people with obesity receive bariatric surgery.”

Ardissino concludes his comments to the AHA with a call for a shift in perception of bariatric surgery, once seen as a cosmetic procedure and not available to the majority of the eligible population. Bariatric surgery, he emphasizes, needs to be viewed as a “potentially death-preventing and standard-of-care procedure that should be discussed with all eligible patients.” 


The study will be presented on Sunday, November 17, 2019, at 6 a.m. during the poster session Best of Stroke Abstracts.

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