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Effectiveness of bariatric metabolic surgery versus glucagon-like peptide-1 receptor agonists for prevention of congestive heart failure


Comparative evidence for the effects of bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RA) on cardiovascular outcomes is limited. Here, in an observational, retrospective cohort study, we compared the incidence of congestive heart failure (CHF) in adults living with obesity and diabetes without history of CHF (primary CHF) treated with BMS versus GLP-1RA. The population cohort comprised members of Clalit Health Services with no prior history of ischemic heart disease, ischemic stroke or CHF. During the time period of 2008–2021, patients who underwent their first BMS were matched 1:1 with patients who initiated treatment with GLP-1RA, based on clinical characteristics. The study included 2,205 matched pairs of patients (64.5% female), followed for a median of 6.6 years and up to 12 years. Primary incidence of CHF occurred in 26 (1.2%) patients treated with BMS and in 90 patients treated with GLP-1RA (4.1%) (adjusted hazard ratio 0.43, 95% confidence interval 0.27–0.68). Further adjustment for weight reduction did not significantly diminish this association (hazard ratio adjusted for weight reduction 0.48, 95% confidence interval 0.28–0.82), indicating that the differential effect was not mediated through the relative advantage of BMS in maximal weight reduction. In this study, BMS was associated with a stronger reduction in primary incidence of CHF compared with treatment with GLP-1RA. With the increasing use of highly potent next-generation GLP-1RAs, further comparative long-term studies are warranted.

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Fig. 1: Patient flow diagram.
Fig. 2: Cumulative hazards for CHF.

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Data availability

Due to Clalit Health Services’ data privacy regulations and per the institutional Helsinki and data utilization committee approvals for this study, the data used for this study cannot be shared.


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No financial or in-kind support was provided for the conduct of this study.

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Authors and Affiliations



All authors contributed to the study design and execution. E.B. extracted the data under the supervision of O.R. N.R. cleaned and analyzed the data with the guidance of Y.W.S. and O.R. Y.W.S., R.A., O.R. and D.D. drafted the initial manuscript and made the primary revisions. D.D. and G.L. planned, revised and approved all the clinical aspects of the study. D.D., G.L. and R.A. oversaw the study design and conduct. All authors revised the manuscript for critical content and clarity and approved it. Y.W.S., G.L. and N.R. contributed equally. D.D., O.R. and R.A. jointly supervised this work.

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Correspondence to Yael Wolff Sagy.

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Competing interests

D.D., G.L. and O.R. reported receiving grants from the Israel Science Foundation outside the submitted work. D.D. reported receiving grants, personal fees and nonfinancial support from NovoNordisk and Eli Lilly; and personal fees and nonfinancial support from Boehringer Ingelheim outside the submitted work. The other authors declared no competing interests.

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Extended data

Extended Data Table 1 Association of participant characteristics and CHF incidence further adjusted for weight reduction
Extended Data Table 2 Results of univariable and multivariable models starting follow-up 12 months after the index date- Sensitivity Analysis

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Wolff Sagy, Y., Lavie, G., Ramot, N. et al. Effectiveness of bariatric metabolic surgery versus glucagon-like peptide-1 receptor agonists for prevention of congestive heart failure. Nat Med (2024).

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