Weight-loss surgery protects the heart more than GLP-1 drugs
Metabolic and bariatric surgery (MBS) is associated with better long-term cardiovascular protection than glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes and obesity, according to a new meta-analysis. The findings were published in full in Obesity Surgery.[1]
“Although both MBS and GLP-1 RAs are effective strategies for improving metabolic outcomes and reducing cardiovascular risk in the individual with obesity and type 2 diabetes, their risk-benefit profiles differ, and direct comparative evidence on long-term major adverse cardiovascular events (MACEs) and all-cause mortality is limited,” wrote Joshua Chadwick, a scientist with the Indian Council of Medical Research, and colleagues.
Chadwick et al. explored data from 11 studies and nearly 20,000 patients. The studies included a mix of randomized controlled trials (RCTs), propensity score-matched cohorts and nationwide matched cohorts. Patients were from the United States, China, Italy, Sweden, Israel, Australia and Taiwan. The most common MBS treatments included in this analysis were Roux-en-Y gastric bypass and sleeve gastrectomy. The most common GLP-1 drugs prescribed to patients were semaglutide (sold by Novo Nordisk under the brand names Wegovy and Ozempic), liraglutide (sold by Novo Nordisk under the brand names Saxenda and VIctosa) and dulaglutide (sold by Lily as Trulicity).
Overall, in terms of MACEs and all-cause mortality, the relative risk reduction for MBS when compared to GLP-1 RA therapy was 52%. A subgroup analysis confirmed that this benefit was consistent across RCTs and observational cohorts. While there were notable differences between these different studies, a sensitivity analysis using the “leave-one out” approach confirmed the validity of the findings.
“The observed benefits of MBS extend beyond glycemic control and weight loss, likely reflecting the multifactorial impact of surgical interventions on metabolic and cardiovascular risk factors,” the authors wrote. “While GLP-1 RAs have demonstrated efficacy in reducing cardiovascular events and improving metabolic parameters, the magnitude of benefit appears greater with surgical intervention, particularly over the long term.”
The authors did emphasize that both treatment options are associated with “substantial” benefits, and they are not pointing to GLP-1 RA therapy as something that is ineffective or unsafe.
“GLP-1 RAs remain an essential therapeutic option for patient’s ineligible for surgery or seeking non-surgical management, though weight regain and long-term cardiovascular outcomes warrant careful consideration,” they wrote. “Clinicians should individualize therapy based on patient risk profiles, preferences and access, with future research needed to clarify the optimal sequencing and combination of interventions, long-term safety and cost-effectiveness in real-world practice.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.