Highlights
- •The Effectiveness of Gastric Bypass vs. Gastric Sleeve for Cardiovascular Disease (ENGAGE CVD) study compared the effectiveness of vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) operations for reduction of the American College of Cardiology (ACA) and the American Heart Association (AHA) predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk 5 years after surgery.
- •Patients (2,771 RYGB and 6,256 VSG) were primarily women (80.6%), Hispanic or non-Hispanic Black (63.7%), were 46±10 years old, with a BMI of 43.40±6.5 kg/m2. The predicted 10-year ASCVD risk at surgery was 4.1% for VSG and 5.1% for RYGB, decreasing to 2.6% for VSG and 2.8% for RYGB 1-year postoperatively. By 5 years after surgery, patients remained with relatively low risk levels (3.0% for VSG and 3.3% for RYGB) and there were no significant differences in predicted 10-year ASCVD risk between VSG and RYGB at any time.
- •For both operations, the prevalence of smoking began to increase immediately following surgery (p<.001). However, all other indicators used for the predicted 10-year ASCVD risk score significantly improved over time (p<.001).
- •Our findings suggest RYGB and VSG provide similar benefits for 10-year risk of cardiovascular disease. Literature reporting significant differences between VSG and RYGB in 10-year ASCVD risk may be a result of residual confounding.
Abstract
Background
Comparative evidence is needed when deciding which bariatric operation to undergo
for long-term cardiovascular risk reduction.
Objectives
The Effectiveness of Gastric Bypass vs. Gastric Sleeve for Cardiovascular Disease
(ENGAGE CVD) study compared the effectiveness of vertical sleeve gastrectomy (VSG)
and Roux-en-Y gastric bypass (RYGB) operations for reduction of the American College
of Cardiology and the American Heart Association–predicted 10-year atherosclerotic
cardiovascular disease (ASCVD) risk 5 years after surgery.
Setting
Data for this study came from a large integrated healthcare system in the Southern
California region of the United States. This is one of the most ethnically diverse
(64% non-White) bariatric populations in the literature.
Methods
The ENGAGE CVD cohort consisted of 22,095 patients who underwent VSG or RYGB from
2009–2016. The VSG and RYGB were compared using a local instrumental variable approach
to address observed and unobserved confounding, as well as to conduct heterogeneity
of treatment effects for patients of different age groups, baseline-predicted 10-year
CVD risk using the ASCVD risk score, and those who had type 2 diabetes (T2D) at the
time of surgery.
Results
Patients (2771 RYGB and 6256 VVSG) were primarily women (80.6%), Hispanic or non-Hispanic
Black (63.7%), and 46 ± 10 years of age, with a body mass index of 43.40 ± 6.5 kg/m2. The predicted 10-year ASCVD risk at surgery was 4.1% for VSG and 5.1% for RYGB,
decreasing to 2.6% for VSG and 2.8% for RYGB 1 year postoperatively. By 5 years after
surgery, patients remained with relatively low risk levels (3.0% for VSG and 3.3%
for RYGB) and there were no significant differences in predicted 10-year ASCVD risk
between VSG and RYGB at any time.
Conclusion
Predicted 10-year ASCVD risk was low in this population and remained low up to 5 years
for those with diabetes, Black and Hispanic patients, and older adults. Literature
reporting significant differences between VSG and RYGB in 10-year ASCVD risk may be
a result of residual confounding.
Key words
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Article info
Publication history
Published online: March 08, 2022
Accepted:
February 27,
2022
Received:
September 17,
2021
Identification
Copyright
© 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: Comparative effectiveness of gastric bypass and sleeve gastrectomy on predicted 10-year risk of cardiovascular disease 5 years after surgerySurgery for Obesity and Related DiseasesVol. 18Issue 7
- PreviewWe read with great interest the study from Basu et al. [1] comparing the predicted 10-year cardiovascular disease risk after sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). They found that both procedures have an equal impact on predicted 10-year cardiovascular risk estimated by the atherosclerotic cardiovascular disease (ASCVD) score. They found an initial decrease in the ASCVD score during the first few years with a gradual increase back to preoperative levels or slightly above during the 5-year follow-up.
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- Preview
- Comment on: Comparative effectiveness of gastric bypass and sleeve gastrectomy on predicted 10-year risk of cardiovascular disease 5 years after surgerySurgery for Obesity and Related DiseasesVol. 18Issue 8
- PreviewFor a preference-sensitive condition such as bariatric surgery, the decision to pursue sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) is often the result of a shared decision-making discussion. Many factors contribute to this choice, including expected weight loss and the likelihood that co-morbid conditions will be improved or eliminated. While bariatric surgery is generally very safe and effective, in some cases a certain operation will help a patient achieve these health goals better than another, and it is the surgeon’s responsibility to provide accurate guidance.
- Full-Text
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