If bariatric surgery has demonstrated its ability to limit diseases associated with obesity and to extend the life expectancy of obese patients. Doubt persists about its influence on the long-term use of medications related to obesity-related diseases, such as hyperlipidemia, cardiovascular diseases and diabetes.
A population-based cohort study, median follow-up of 7 years
Scandinavian authors carried out this work using registers of obese adults in Sweden and Finland, between 1995 and 2020. These registers provide precise information on bariatric surgery interventions as well as the number, type and dose of medications prescribed. . Bariatric surgery could have consisted of gastric bypass (GCC) or calibrated vertical gastrectomy (GVC, or sleeve gastrectomy).
The operated patients (GO) were matched in the proportion of 1:5 with a control group (GNO) of comparable obese subjects (age, sex, medications, etc.) not operated on.
The main endpoint was the change in medication prescriptions during follow-up: lipid-lowering agents (statins, fibrates), cardiovascular medications (anti-hypertensives, antiarrhythmics, diuretics, vasodilators, beta-blockers, etc.), antidiabetics (insulins, sulfonamides, metformin, gliflozins, gliptins, etc.).
The GO included 26,396 operations and the GNO 131,980 obese subjects, with a median follow-up of 7 years and just under 6 years, respectively. In the two groups, which were perfectly comparable, there were two thirds of women and the median age was 50 years.
A reduction in drug prescriptions after surgery
-All those operated on had been subjected to the three categories of medications during the 6 months preceding the operation.
Concerning lipid-lowering drugs, in GO we see a drop in their use after 2 years (from 20 to 13%) then a recovery reaching 17% at 15 years. This consumption is still much lower than that of GNO, whose LA consumption increases from 20 to 44% after 15 years.
The same is true for cardiovascular medications, initially consumed by 60% of GO subjects and whose use only concerns 43% of those undergoing surgery after 2 years but rises to 73% at 15 years. In the GNO group, we go from 58% to 83% after 15 years.
As for antidiabetics, their initial consumption of 28% in the GO increased at 2 and 15 years to 10 and 23.5%, these figures remaining well below those of the GNO, which increased from 28% to 54% after 15 years.
Overall, the probability of prescribing a lipid-lowering, antidiabetic or cardiovascular medication was lower after bariatric surgery than in the control group at all follow-up periods. However, the decline is more lasting for the first two categories of drugs than for the last.
