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Effectiveness of Bariatric Metabolic Surgery versus Glucagon-Like Peptide-1 Receptor Agonists for prevention of Congestive Heart Failure.

Nature Medicine 2024 May 16
Comparative evidence for the effects of bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP1-RA) on cardiovascular outcomes is limited. Here, in an observational, retrospective cohort study, we compared the incidence of Congestive Heart Failure (CHF) in adults living with obesity and diabetes without history of CHF (primary CHF) treated with BMS versus GLP-1RA. The population cohort comprised members of Clalit Health Services with no prior history of ischemic heart disease, ischemic stroke, or CHF. During the time period of 2008 - 2021, patients who underwent their first BMS were matched 1:1 with patients who initiated treatment with GLP-1RA, based on clinical characteristics. The study included 2,205 matched pairs of patients (64.5% female), followed for a median of 6.6 years and up to 12 years. Primary incidence of CHF occurred in 26 (1.2%) BMS patients and in 90 GLP1-RA patients (4.1%), adjusted HR: 0.43, 95% CI: 0.27-0.68. Further adjustment for weight reduction did not significantly diminish this association, HR adjusted for weight reduction: 0.48, 95% CI 0.28-0.82, indicating that the differential effect was not mediated through the relative advantage of BMS in maximal weight reduction. In this study, BMS was associated with a stronger reduction in primary incidence of CHF compared to treatment with GLP1-RA. With the increasing use of highly potent next-generation GLP1-RAs, further comparative long-term studies are warranted.

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