title: Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes.
abstract: OBJECTIVE
  Obese individuals with type 2 diabetes have an increased risk of cardiovascular disease. The effect of bariatric surgery on cardiovascular events in obese individuals with type 2 diabetes remains to be determined. The Swedish Obese Subjects (SOS) study is a prospective, controlled intervention study that examines the effects of bariatric surgery on hard end points. The aim of the present study was to examine the effect of bariatric surgery on cardiovascular events in the SOS study participants with type 2 diabetes.
  
  
  METHODS
  All SOS study participants with type 2 diabetes at baseline were included in the analyses (n = 345 in the surgery group and n = 262 in the control group). Mean follow-up was 13.3 years (interquartile range 10.2-16.4) for all cardiovascular events.
  
  
  RESULTS
  Bariatric surgery was associated with a reduced myocardial infarction incidence (38 events among the 345 subjects in the surgery group vs. 43 events among the 262 subjects in the control group; log-rank P = 0.017; adjusted hazard ratio [HR] 0.56 [95% CI 0.34-0.93]; P = 0.025). No effect of bariatric surgery was observed on stroke incidence (34 events among the 345 subjects in the surgery group vs. 24 events among the 262 subjects in the control group; log-rank P = 0.852; adjusted HR 0.73 [0.41-1.30]; P = 0.29). The effect of surgery in reducing myocardial infarction incidence was stronger in individuals with higher serum total cholesterol and triglycerides at baseline (interaction P value = 0.02 for both traits). BMI (interaction P value = 0.12) was not related to the surgery outcome.
  
  
  CONCLUSIONS
  Bariatric surgery reduces the incidence of myocardial infarction in obese individuals with type 2 diabetes. Preoperative BMI should be integrated with metabolic parameters to maximize the benefits of bariatric surgery.
authors.affiliation: Department of Molecular and Clinical Medicine and Center for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. stefano.romeo@wlab.gu.se
authors.forename: Stefano
authors.initials: S
authors.lastname: Romeo
authors.forename: Cristina
authors.initials: C
authors.lastname: Maglio
authors.forename: Maria Antonella
authors.initials: MA
authors.lastname: Burza
authors.forename: Carlo
authors.initials: C
authors.lastname: Pirazzi
authors.forename: Kajsa
authors.initials: K
authors.lastname: Sjöholm
authors.forename: Peter
authors.initials: P
authors.lastname: Jacobson
authors.forename: Per-Arne
authors.initials: PA
authors.lastname: Svensson
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
authors.forename: Lars
authors.initials: L
authors.lastname: Sjöström
authors.forename: Lena M S
authors.initials: LM
authors.lastname: Carlsson
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000601:surgery*; D020521:Stroke / Q000097:blood / Q000453:epidemiology / Q000209:etiology