New study finds gastric bypass most effective for improving cardiac structure among bariatric surgeries
A new systematic review and network meta-analysis published in our journal Obesity Reviews explores the comparative effectiveness of different bariatric surgeries on improving cardiac structure and function in adults with obesity.
The study, led by researchers from the China-Japan Friendship Hospital and Beijing University of Chinese Medicine, reveals that gastric bypass surgery shows the most significant improvements in cardiac structure, although no significant improvement in cardiac function was observed across all surgeries.
Obesity is a major global health concern, with increasing prevalence leading to higher rates of cardiovascular disease and other serious health complications. Bariatric surgeries, such as gastric bypass, sleeve gastrectomy, adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPD-DS), have become popular treatment options for severe obesity and its associated comorbidities. However, the relative effectiveness of these procedures on heart health had not been comprehensively compared—until now.
Key findings: Gastric bypass shows the greatest cardiac benefits
The review analysed 19 studies involving over 2,000 adults with obesity to assess the impact of various bariatric surgeries on key cardiac indicators, including left ventricular mass (LVM), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF). The results showed that gastric bypass surgery led to the most significant reductions in LVM and LVMI compared to other surgical procedures and non-surgical interventions.
For example, the study found that patients who underwent gastric bypass experienced a weighted mean reduction of 43.86 grams in LVM compared to placebo, and a standardised mean reduction of 0.67 in LVMI. Sleeve gastrectomy and AGB were less effective in reducing these cardiac indicators.
Read the study
Despite these positive effects on cardiac structure, none of the bariatric surgeries studied—including gastric bypass—showed significant improvements in cardiac function, as measured by LVEF. The study suggests that while these surgeries are beneficial in reversing the structural changes in the heart caused by obesity, they may not significantly enhance overall heart function in the short term.
Impact of bariatric surgeries on BMI
In addition to the cardiac benefits, the study ranked the effectiveness of each surgery in reducing body mass index (BMI). BPD-DS was found to be the most effective in reducing BMI, followed by gastric bypass, sleeve gastrectomy and AGB. BPD-DS led to an average weighted mean difference of 16.33 kg/m² in BMI (when compared to placebo), while gastric bypass resulted in a difference of 12.33 kg/m². Body weight was significantly reduced by all bariatric surgeries.
Need for further research
While the study provides valuable insights into the relative benefits of different bariatric surgeries, the authors acknowledge that further research is needed to better understand the long-term effects of these procedures on both cardiac structure and function. Specifically, the study calls for more large-scale clinical trials to explore the molecular mechanisms underlying these changes and to determine whether improvements in heart structure can eventually lead to better cardiac function over time.
This systematic review and network meta-analysis offers important evidence that gastric bypass surgery is the most effective option for improving cardiac structure in adults with obesity. However, given the lack of significant improvements in cardiac function, more research is needed to fully understand the cardiovascular benefits of bariatric surgeries.
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World Obesity publishes four scientific, peer-reviewed journals, each focusing on a different area of obesity research: systematic reviews, pediatrics, clinical treatment, and science and practice.
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