Original article| Volume 18, ISSUE 5, P610-619, May 2022

The impact of bariatric surgery on the risk of coronary revascularization

Published:January 25, 2022DOI:


      • Bariatric surgery reduces the risk of follow-up overall coronary revascularization
      • Future CABG and PCI risks are reduced in the metabolic surgery cohort
      • Less revascularization is observed in bypass compared to gastric banding



      Metabolic surgery is associated with improved cardiovascular risk profile. Randomized and observational studies exploring the impact of bariatric surgery on follow-up coronary revascularization (CR) as a primary endpoint are limited.


      To identify the impact of metabolic surgery on the risk of follow-up CR, including percutaneous coronary revascularization (PCI) and coronary artery bypass grafting (CABG)


      Stony Brook Department of Surgery, Stony Brook University Hospital, New York, United States.


      A retrospective analysis was performed for patients with obesity between 2006 and September 2015. Patients were divided into those with history of metabolic surgery and those without. Patient were also stratified by bariatric surgery type. All study groups were followed till 2018 and for at least 3 years to monitor the development of the primary endpoint—any CR including PCI or CABG.


      The study population with obesity was 515,307 patients; 95,901 with history of surgery versus 419,406 matched patients without. A total of 12,873 (13.4%) with surgery and 51,478 (12.27%) without were lost to follow-up by 2018. The group with history of surgery had a reduced risk of future CR (hazard ratio [HR], .46; 95% confidence interval [CI]: .42–.50; P < .0001), PCI (HR, .45; 95% CI: .41–.49; P < .0001) and CABG (HR, .49; 95% CI:.42–.56; P < .0001). In subgroup analysis, laparoscopic adjustable gastric banding compared with Roux-en-Y gastric bypass (RYGB) was associated with higher follow-up CR (HR, 1.34; 95% CI: 1.11–1.63; P < .01) and PCI (HR, 1.34; 95% CI: 1.07–1.68; P < .05).


      Bariatric surgery is associated with reduced risk of future CR, PCI, and CABG. Upon subgroup analysis, RYGB was associated with reduced risk of PCI and CR.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Benotti P.N.
        • Wood G.C.
        • Carey D.J.
        • et al.
        gastric bypass surgery produces a durable reduction in cardiovascular disease risk factors and reduces the long-term risks of congestive heart failure.
        J Am Heart Assoc. 2017; 6e005126
        • Van Gaal L.
        • Mertens I.
        • De Block C.
        Mechanisms linking obesity with cardiovascular disease.
        Nature. 2006; 444: 875-880
        • Bays H.
        Adiposopathy: is “sick fat” a cardiovascular disease?.
        J Am Coll Cardiol. 2011; 57: 2461-2473
        • Rosen E.
        • Spiegleman B.
        Adipocytes as regulators of energy balance and glucose homeostasis.
        Nature. 2006; 444: 847-853
        • Mechanick J.I.
        • Apovian C.
        • Brethauer S.
        • et al.
        Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists - executive summary.
        Endocr Pract. 2019; 25: 1346-1359
        • Aminian A.
        • Zajichek A.
        • Tu C.
        • et al.
        How much weight loss is required for cardiovascular benefits? insights from a metabolic surgery matched-cohort study.
        Ann Surg. 2020; 272: 639-645
        • Moussa O.
        • Ardissino M.
        • Heaton T.
        • et al.
        Effect of bariatric surgery on long-term cardiovascular outcomes: a nationwide nested cohort study.
        Eur Heart J. 2020; 41: 2660-2667
      1. Brown AM, Yang J, Zhang X, Docimo S, Pryor AD, Spaniolas K. Bariatric surgery lowers the risk of major cardiovascular events. Ann Surg. Epub 2020 Nov 18.

        • Sjöström L.
        • Narbro K.
        • Sjöström C.D.
        • et al.
        Effects of bariatric surgery on mortality in Swedish obese subjects.
        N Engl J Med. 2007; 357: 741-752
        • Aminian A.
        • Zajichek A.
        • Arterburn D.E.
        • et al.
        Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity.
        JAMA. 2019; 322: 1271-1282
        • Fisher D.P.
        • Johnson E.
        • Haneuse S.
        • et al.
        Association between bariatric surgery and macrovascular disease outcomes in patients with type 2 diabetes and severe obesity.
        JAMA. 2018; 320: 1570-1582
        • Michaels A.D.
        • Mehaffey J.H.
        • Hawkins R.B.
        • Kern J.A.
        • Schirmer B.D.
        • Hallowell P.T.
        Bariatric surgery reduces long-term rates of cardiac events and need for coronary revascularization: a propensity-matched analysis.
        Surg Endosc. 2020; 34: 2638-2643
        • Hirji S.A.
        • Percy E.D.
        • Zogg C.K.
        • et al.
        Comparison of in-hospital outcomes and readmissions for valve-in-valve transcatheter aortic valve replacement vs. reoperative surgical aortic valve replacement: a contemporary assessment of real-world outcomes.
        Eur Heart J. 2020; 41: 2747-2755
        • Maciejewski M.L.
        • Arterburn D.E.
        • Van Scoyoc L.
        • et al.
        Bariatric surgery and long-term durability of weight loss.
        JAMA Surg. 2016; 151: 1046-1055
        • Mingrone G.
        • Panunzi S.
        • De Gaetano A.
        • et al.
        Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial.
        Lancet. 2015; 386: 964-973
        • Batsis J.A.
        • Romero-Corral A.
        • Collazo-Clavell M.L.
        • et al.
        Effect of weight loss on predicted cardiovascular risk: change in cardiac risk after bariatric surgery.
        Obesity (Silver Spring). 2007; 15: 772-784
        • Sjöström L.
        • Peltonen M.
        • Jacobson P.
        • et al.
        Bariatric surgery and long-term cardiovascular events.
        JAMA. 2012; 307: 56-65
        • Adams T.D.
        • Gress R.E.
        • Smith S.C.
        • et al.
        Long-term mortality after gastric bypass surgery.
        N Engl J Med. 2007; 357: 753-761
      2. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014 Jun 24;129(25 Suppl 2):S102–S138.

        • Benjamin E.J.
        • Virani S.S.
        • Callaway C.W.
        • et al.
        Heart disease and stroke statistics-2018 update: a report from the American Heart Association.
        Circulation. 2018; 137: e67-e492
        • Powell-Wiley T.M.
        • Poirier P.
        • Burke L.E.
        • et al.
        Obesity and cardiovascular disease: a scientific statement from the American Heart Association.
        Circulation. 2021; 143: e984-e1010
        • Courcoulas A.P.
        • King W.C.
        • Belle S.H.
        • et al.
        Seven-year weight trajectories and health outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) study.
        JAMA Surg. 2018; 153: 427-434
        • Tice J.A.
        • Karliner L.
        • Walsh J.
        • Petersen A.J.
        • Feldman M.D.
        Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures.
        Am J Med. 2008; 121: 885-893
        • Korner J.
        • Inabnet W.
        • Febres G.
        • et al.
        Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass.
        Int J Obes (Lond). 2009; 33: 786-795
        • McTigue K.M.
        • Wellman R.
        • Nauman E.
        • et al.
        Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass.
        JAMA Surg. 2020; 155e200087
        • Schultz W.M.
        • Kelli H.M.
        • Lisko J.C.
        • et al.
        Socioeconomic status and cardiovascular outcomes: challenges and interventions.
        Circulation. 2018; 137: 2166-2178

      Linked Article

      • Comment on: The impact of bariatric surgery on the risk of coronary revascularization
        Surgery for Obesity and Related DiseasesVol. 18Issue 5
        • Preview
          We read with great interest the study from Noubani et al. [1], which provides retrospective data on the impact of bariatric surgery on coronary revascularization, extracted from the New York State Statewide Planning and Research Cooperative System (SPARCS) database. The authors identified more than 500,000 patients with obesity (BMI >30 kg/m2) and compared those who had undergone bariatric surgery with those who had not. Patients were matched in a 1:5 ratio according to a range of variables. The primary outcome was coronary revascularization (CR), defined by percutaneous coronary intervention, coronary artery bypass grafting, or both.
        • Full-Text
        • PDF