Weight Loss Surgery Bests Medical Therapy for Reducing CVD in Obese Teens

This study was originally published on PracticalCardiology.com.

Petter Bjornstad, MD

A recent comparison by investigators at Children’s Hospital Colorado is offering insight into the effects of bariatric surgery versus standard medical therapy on future cardiovascular disease risk in obese teens with type 2 diabetes.

An analysis of the Teen-LABS and the TODAY studies, results suggest undergoing bariatric surgery was associated with nearly 3-fold reductions in long-term risk of heart attack, congestive heart failure, stroke, and coronary death among teenagers with type 2 diabetes compared to those only managed medically.

"Bariatric surgery is currently the only treatment available for youth with severe obesity and type 2 diabetes that results in considerable and durable weight loss and improvement in blood sugar levels in the majority of patients. With this study, our intent was to further demonstrate the benefits of bariatric surgery in adolescents by proving that it also leads to significantly lower long-term risks of cardiovascular disease,” said lead investigator Petter Bjornstad, MD, an endocrinologist at Children's Hospital Colorado, in a statement.

With the prevalence and societal burden of obesity and type 2 diabetes continuing to grow, Bjornstad and a team of colleagues sought to compare the 30-year risk for cardiovascular disease events among patients with type 2 diabetes and severe obesity. To do so, investigators designed their study to compare data collected from patients in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies.\

From Teen-LABS, investigators identified a cohort of 30 participants who were of similar age and racial distribution as the 63 patients identified from the TODAY study for inclusion in the study. Of note, all patients from the Teen-LABS study underwent bariatric surgery and those from the TODAY study received metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression.

Patients from Teen-LABS had a mean age of 16.9 (SD, 1.3) years, 70% were female, 60% were white, and the mean BMI was 54.4 (SD, 9.5) kg/m2. Patients from TODAY had a mean age of 15.3 (SD, 1.3) years, 56% were female, 71% were white, and the mean BMI was 40.5 (SD, 4.9) kg/m2.

The primary outcome of the analysis was the difference in 30-year cardiovascular disease event score developed by the Framingham Heart Study. Investigators assessed this risk at baseline and again after 1 year and 5 years of follow-up.

At baseline, the likelihood of cardiovascular disease events was higher among those in Teen-LABS study than those in the TODAY study (17.66 [SD, 1.33] vs 12.11 [SD, .79]; P=.002). After 1 year, analysis indicated those in Teen-LABS had a significantly lower event risk than those in TODAY (6.79 [SD, 1.33] vs 13.64 [SD, 0.96]; P <.0001). Further analysis indicated this difference was sustained through the 5-year follow-up (adjusted P <.0001).

"The high cardiovascular disease risk observed in TODAY participants, despite their lower baseline BMI, underscores the inadequacy of standard medical therapy in mitigating the risk of cardiovascular events, and calls for more aggressive therapy in this at-risk population," said Thomas H. Inge, MD, PhD, Teen-LABS principal investigator, and director of pediatric surgery and the bariatric center at Children's Hospital Colorado, in the aforementioned statement. "While longer-term studies are needed to determine whether the risk score predictions hold true, the long-term cardiovascular health prospects associated with bariatric surgery in adolescents appear to be very positive."

This study, “Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity,” was published in Surgery for Obesity and Related Diseases.