Although bariatric surgery was associated with a lower 10-year incidence of major adverse cardiovascular events including death, residual risk was still high.

Patients with obstructive sleep apnoea (OSA) are at higher risk for major adverse cardiovascular events (MACE). Although obesity is a strong risk factor for OSA, it is unknown whether intentional weight loss decreases the risk for MACE or death in these patients.

To examine this possibility, investigators retrospectively compared outcomes between nearly 1000 adults with moderate-to-severe OSA who underwent bariatric surgery for a body mass index (BMI) of 35 to 70 kg/m² and nearly 13,000 patients with OSA and obesity who did not undergo surgery. The primary endpoint was the first occurrence of MACE, which included coronary artery events, cerebrovascular events, heart failure, atrial fibrillation and all-cause death.

At 10 years, mean weight loss was 33 kg in patients who underwent bariatric surgery and 7 kg in the nonsurgical comparison group. Surgery recipients had significantly lower 10-year cumulative incidences of MACE (27% vs 36%) and all-cause mortality (9% vs 13%) compared with the nonsurgical group.

Comment: Although the standard disclaimers apply regarding limitations of observational studies, this large cohort study adds to the growing body of evidence linking excess weight with worse outcomes. What strikes me about these data are the high residual risks for MACE and death experienced by the surgical group despite successful and sustained weight loss. These findings will prompt me to be more vigilant in my patients with OSA and obesity by 1) discussing all current weight-loss options, and 2) ensuring that their other CV risk factors are well modified.

Shea E. Hogan, MD, MSCS, FACC, FSCAI, FSVM, Interventional Cardiologist, Denver Health; Associate Professor of Clinical Medicine, University of Colorado School of Medicine; Clinician-Scientist, CPC Clinical Research, Denver, USA.

Aminian A, et al. Adverse cardiovascular outcomes in patients with obstructive sleep apnea and obesity: metabolic surgery vs usual care. J Am Coll Cardiol 2024 Jun 21; e-pub (https://doi.org/10.1016/j.
jacc.2024.06.008).

This summary is taken from the following Journal Watch titles: Cardiology, Hospital Medicine.