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Cardiovascular, cancer and mortality events after bariatric surgery in people with and without pre-existing diabetes : a nationwide study

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Dhalwani, Nafeesa N., Zaccardi, Francesco, Waheed, Hina, Mytton, Jemma, Papamargaritis, Dimitris, Webb, David R., Evison, Felicity, Lilford, Richard, Davies, Melanie J. and Khunti, Kamlesh (2019) Cardiovascular, cancer and mortality events after bariatric surgery in people with and without pre-existing diabetes : a nationwide study. Journal of Diabetes, 11 (4). pp. 265-272. doi:10.1111/1753-0407.12851

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Official URL: https://doi.org/10.1111/1753-0407.12851

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Abstract

Background

Bariatric surgery reduces cardiovascular events and mortality risk in obese individuals. However, it is unclear whether diabetes modifies this effect. This study examined mortality, cardiovascular, and cancer risk following bariatric surgery in adults with and without pre‐existing diabetes.

Methods

Using mortality‐linked Hospital Episodes Statistics (2006‐14) from England, the risk of death, myocardial infarction, stroke, unstable angina, heart failure, and cancer following bariatric surgery was examined; the risk of death in people undergoing surgery was also compared with mortality rates of the general population.

Results

Of the 35 887 people undergoing bariatric surgery, 9175 (25.6%) had pre‐existing diabetes. During a mean follow‐up of 5.3 years, 801 people died, of whom 293 (36.6%) had pre‐existing diabetes. The risk of all‐cause mortality was 26% higher in people with than without diabetes (adjusted hazard ratio [aHR] 1.26, 95% confidence interval [CI] 1.08‐1.46), whereas the risk of cancer was 21% higher (aHR 1.21; 95% CI 1.14‐1.77). The risk of cardiovascular events was higher for patients with than without diabetes (aHRs [95% CIs] 2.08 [1.42‐3.05], 1.80 [1.29‐2.52], 1.61 [1.18‐2.19], and 1.42 [1.14‐1.77] for myocardial infarction, unstable angina, stroke, and heart failure, respectively). Compared with the general population, the age‐standardized mortality rate ratio was 1.70 (1.52‐1.91) and 1.35 (1.23‐1.48) in people with and without pre‐existing diabetes, respectively.

Conclusions

For patients with pre‐existing diabetes, the risk of death, cardiovascular events, and cancer after bariatric surgery was higher than for those without diabetes, whose mortality risk after surgery remains 35% higher than that of the general population.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Library of Congress Subject Headings (LCSH): Diabetes, Cancer, Cardiovascular system -- Diseases, Obesity -- Surgery
Journal or Publication Title: Journal of Diabetes
Publisher: Wiley-Blackwell Publishing, Inc.
ISSN: 1753-0393
Official Date: April 2019
Dates:
DateEvent
April 2019Published
7 September 2018Available
7 October 2018Updated
31 August 2018Accepted
Volume: 11
Number: 4
Page Range: pp. 265-272
DOI: 10.1111/1753-0407.12851
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIED[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
UNSPECIFIEDSanofi aventis (Firm)http://viaf.org/viaf/130547280
UNSPECIFIEDNovo Nordiskhttp://dx.doi.org/10.13039/501100004191
UNSPECIFIEDNovartishttp://dx.doi.org/10.13039/100004336
UNSPECIFIEDEli Lilly and Companyhttp://dx.doi.org/10.13039/100004312
UNSPECIFIEDPfizerhttp://dx.doi.org/10.13039/100004319
UNSPECIFIEDBoehringer Ingelheimhttp://dx.doi.org/10.13039/100008349
UNSPECIFIEDMerck Sharp and Dohmehttp://dx.doi.org/10.13039/100009947
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