AIMS This study aims to evaluate the long-term effect of bariatric surgery on cardiovascular outcomes of patients with obesity. METHODS AND RESULTS A nested cohort study was carried out within the Clinical Practice Research Datalink. The study cohort included the 3701 patients on the database who had undergone bariatric surgery and 3701 age, gender, and body mass index-matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction and fatal or non-fatal ischaemic stroke. Secondary endpoints included fatal or non-fatal myocardial infarction alone, fatal or non-fatal ischaemic stroke alone, incident heart failure, and mortality. The median follow-up achieved was 11.2 years. Patients who had undergone bariatric surgery had a significantly lower occurrence of major adverse cardiovascular events [hazard ratio (HR) 0.410, 95% confidence interval (CI) 0.274-0.615; P < 0.001]. This was mainly driven by a reduction in myocardial infarction (HR 0.412, 95% CI 0.280-0.606; P < 0.001) and not in acute ischaemic stroke (HR 0.536, 95% CI 0.164-1.748; P = 0.301). A reduction was also observed in new diagnoses of heart failure (HR 0.403, 95% CI 0.181-0.897; P = 0.026) and mortality (HR 0.254, 95% CI 0.183-0.353; P < 0.001). CONCLUSION The results of this large, nationwide cohort study support the association of bariatric surgery with lower long-term risk of major cardiovascular events and incident heart failure in patients with obesity.

中文翻译：

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减肥手术对长期心血管结局的影响：一项全国性的嵌套队列研究

目的 本研究旨在评估减肥手术对肥胖患者心血管结局的长期影响。方法和结果 在临床实践研究数据链中进行了一项嵌套队列研究。该研究队列包括数据库中接受过减肥手术的 3701 名患者和 3701 名年龄、性别和体重指数匹配的对照。主要终点是致死性或非致死性心肌梗死和致死性或非致死性缺血性卒中的复合终点。次要终点包括单独的致死性或非致死性心肌梗塞、单独的致死性或非致死性缺血性中风、突发性心力衰竭和死亡率。中位随访时间为 11.2 年。接受减肥手术的患者主要不良心血管事件的发生率显着降低 [风险比 (HR) 0.410，95% 置信区间 (CI) 0.274-0.615；P < 0.001]。这主要是由于心肌梗死减少（HR 0.412，95% CI 0.280-0.606；P < 0.001）而不是急性缺血性卒中（HR 0.536，95% CI 0.164-1.748；P = 0.301）。新诊断的心力衰竭（HR 0.403，95% CI 0.181-0.897；P = 0.026）和死亡率（HR 0.254，95% CI 0.183-0.353；P < 0.001）也有所减少。结论这项大型全国性队列研究的结果支持减肥手术与肥胖患者发生主要心血管事件和心力衰竭的较低长期风险之间存在关联。这主要是由于心肌梗死减少（HR 0.412，95% CI 0.280-0.606；P < 0.001）而不是急性缺血性卒中（HR 0.536，95% CI 0.164-1.748；P = 0.301）。新诊断的心力衰竭（HR 0.403，95% CI 0.181-0.897；P = 0.026）和死亡率（HR 0.254，95% CI 0.183-0.353；P < 0.001）也有所减少。结论这项大型全国性队列研究的结果支持减肥手术与肥胖患者发生主要心血管事件和心力衰竭的长期风险较低之间存在关联。这主要是由于心肌梗死减少（HR 0.412，95% CI 0.280-0.606；P < 0.001）而不是急性缺血性卒中（HR 0.536，95% CI 0.164-1.748；P = 0.301）。新诊断的心力衰竭（HR 0.403，95% CI 0.181-0.897；P = 0.026）和死亡率（HR 0.254，95% CI 0.183-0.353；P < 0.001）也有所减少。结论这项大型全国性队列研究的结果支持减肥手术与肥胖患者发生主要心血管事件和心力衰竭的较低长期风险之间存在关联。95% CI 0.183-0.353；P < 0.001)。结论这项大型全国性队列研究的结果支持减肥手术与肥胖患者发生主要心血管事件和心力衰竭的较低长期风险之间存在关联。95% CI 0.183-0.353；P < 0.001)。结论这项大型全国性队列研究的结果支持减肥手术与肥胖患者发生主要心血管事件和心力衰竭的较低长期风险之间存在关联。