Impact of Bariatric Surgery on Heart Disease Compared to Standard Care
- Conditions
- Obesity, MorbidHeart DiseasesBariatric Surgery Candidate
- Interventions
- Procedure: Bariatric surgeryProcedure: Standard care
- Registration Number
- NCT06346145
- Lead Sponsor
- Danderyd Hospital
- Brief Summary
Obesity is associated with type 2 diabetes (T2D) and cardiovascular disease (CVD). Metabolic and bariatric surgery (MBS) has in several randomized controlled trials (RCT) been shown to be superior to best medical therapy in the treatment of T2D. In the area of CVD, RCT after MBS are lacking. It was recently demonstrated in a cohort study that MBS in patients with severe obesity and a previous myocardial infarction (MI) was associated with a 50% reduction in the risk of death and new MI. The aim of this proposal is to confirm this in a nationwide RCT. Using the nationwide SWEDEHEART database patients with severe obesity and a previous MI will be identified. They will be contacted and offered participation. After informed consent the patients will be randomized to MBS or optimized care (including visit with a cardiologist and optimization of secondary preventive measures and referral to dietician/physiotherapist). The primary outcome measure is a major cardiovascular adverse event (MACE). Secondary outcome measures include mortality, new MI, stroke, heart failure and atrial fibrillation. Tertiary outcome measures include health related quality of life and surgical complications. Patients will be followed in the nationwide metabolic surgery register SOReg, the national inpatient register, national cause of death register, the Swedish prescribed drug register, and the Swedish population register. If positive results these can be included in guidelines for MBS.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 500
- MI (as defined by the universal definition of MI) at least 1 year before inclusion.
- BMI ≥35 kg/m2
- Written informed consent obtained
- Any condition that may influence the patient's ability to comply with study protocol.
- Earlier MBS or operation for gastric or duodenal ulcer or reflux disease
- Other condition that makes patient not suitable for MBS according to responsible surgeon and anesthesiologist
- Unable to understand Swedish.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Bariatric surgery Bariatric surgery Gastric bypass or gastric sleeve Standard care Standard care Standard obesity treatment offered in Swedish regions
- Primary Outcome Measures
Name Time Method MACE defined as first occurrence of death (all-cause mortality), MI, stroke, myocardial revascularization (not related to MI), hospital admission because of heart failure or atrial fibrillation as a primary ICD diagnosis. Through study completion, expected average of 6 years Data will be obtained for the Swedish national patient registry and other national quality registries.
- Secondary Outcome Measures
Name Time Method Remission of type 2 diabetes (T2D) and hypertension Through study completion, expected average of 6 years Number of patients in remission
Stroke Through study completion, expected average of 6 years Data will be obtained for the Swedish national national quality registries.
Myocardial infarction Through study completion, expected average of 6 years Data will be obtained for the Swedish national national quality registries.
hospital admission because of atrial fibrillation as a primary ICD diagnosis. Through study completion, expected average of 6 years Data will be obtained for the Swedish national national quality registries.
Myocardial revascularization (not related to MI) Through study completion, expected average of 6 years Data will be obtained for the Swedish national national quality registries.
All-cause mortality Through study completion, expected average of 6 years Data will be obtained for the Swedish national national quality registries.
Cardiovascular death Through study completion, expected average of 6 years Data will be obtained for the Swedish national national quality registries.
hospital admission because of heart failure as a primary ICD diagnosis. Through study completion, expected average of 6 years Data will be obtained for the Swedish national national quality registries.
Total event rate Through study completion, expected average of 6 years Based on events listed in the primary outcome measure. Data will be obtained for the Swedish national patient registry and other national quality registries.