Abstract 16851: Weight Loss and Heart Failure
Introduction: Associations of obesity with incidence of heart failure have been observed, but the causality is uncertain.
Hypothesis: Bariatric surgery leads to lower incidence of heart failure compared to intensive lifestyle modification in obese people, due to its larger effect on weight loss.
Methods: We included obese people without previous heart failure from a Swedish nationwide registry of people treated with a structured intensive lifestyle program, and the Scandinavian Obesity Surgery Registry. All analyses used inverse probability weights, based on baseline body-mass index and a propensity score estimated using baseline variables. Treatment groups were well balanced. Associations of treatment with heart failure incidence, as defined in the National Patient Register, were analyzed using Cox regression.
Results: The 25,804 bariatric surgery patients had on average lost 18.8 kg more weight after 1 year, and 22.6 kg more after 2 years, than the 13,701 lifestyle modification patients. During a median of 4.1 years, surgery patients had lower heart failure incidence than lifestyle modification patients (hazard ratio 0.54, 95% CI 0.36-0.82). In mediation analyses, the associations appeared not to be mediated by effects of weight loss on myocardial infarction, but partly by interim atrial fibrillation, diabetes and hypertension. Results were robust in sensitivity analyses.
Conclusions: Bariatric surgery was associated with a nearly halved incidence of heart failure compared to intensive lifestyle modification, in this study of two large nationwide registries. This suggests a causal effect of obesity on heart failure, the leading cause of hospitalization in Western societies.
Author Disclosures: J. Sundstrom: Consultant/Advisory Board; Modest; Itrim. G. Bruze: None. J. Ottosson: Other; Modest; Director of SOReg (Scandinavian Obesity Surgery Registry). C. Marcus: Consultant/Advisory Board; Modest; Itrim. I. Näslund: None. M. Neovius: Consultant/Advisory Board; Modest; Itrim.
- © 2016 by American Heart Association, Inc.