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Weight Loss and Heart Failure: A Nationwide Study of Gastric Bypass Surgery Versus Intensive Lifestyle Treatment
Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Örebro University Hospital. Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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2017 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 135, no 17, 1577-1585 p.Article in journal (Refereed) Published
Abstract [en]

Background: Associations of obesity with incidence of heart failure have been observed, but the causality is uncertain. We hypothesized that gastric bypass surgery leads to lower incidence of heart failure compared to intensive lifestyle modification in obese people.

Methods: We included obese people without previous heart failure from a Swedish nationwide registry of people treated with a structured intensive lifestyle program, and the Scandinavian Obesity Surgery Registry. All analyses used inverse probability weights, based on baseline body-mass index and a propensity score estimated using baseline variables. Treatment groups were well balanced regarding weight, body mass index and most potential confounders. Associations of treatment with heart failure incidence, as defined in the National Patient Register, were analyzed using Cox regression.

Results: The 25,804 gastric bypass surgery patients had on average lost 18.8 kg more weight after 1 year, and 22.6 kg more after 2 years, than the 13,701 lifestyle modification patients. During a median of 4.1 years, surgery patients had lower heart failure incidence than lifestyle modification patients (hazard ratio 0.54, 95% CI 0.36-0.82). A 10 kg achieved weight loss after 1 year was related to a hazard ratio for heart failure of 0.77, 95% confidence interval 0.60 to 0.97, in both treatment groups combined. Results were robust in sensitivity analyses.

Conclusions: Gastric bypass surgery was associated with approximately one half the incidence of heart failure compared with intensive lifestyle modification in this study of two large nationwide registries. We also observed a graded association between increasing weight loss and decreasing risk of heart failure.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2017. Vol. 135, no 17, 1577-1585 p.
Keyword [en]
bariatric surgery, gastric bypass, heart failure, low calorie diet, weight loss
National Category
Surgery Cardiac and Cardiovascular Systems
Research subject
Surgery; Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-57388DOI: 10.1161/CIRCULATIONAHA.116.025629ISI: 000400006400008PubMedID: 28258170Scopus ID: 2-s2.0-85018280765OAI: oai:DiVA.org:oru-57388DiVA: diva2:1093577
Funder
Swedish Research Council, 2013-3770 2010-1078
Note

Funding Agency:

National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health  R01DK105948

Available from: 2017-05-08 Created: 2017-05-08 Last updated: 2017-09-11Bibliographically approved

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