Efficacy of Metabolic and Bariatric Surgery Compared with GLP-1 Receptor Agonist Treatment in Preventing Mortality and Major Adverse Cardiac Events Among Individuals with Obesity and Type 2 Diabetes: A Systematic Review and Meta-analysis.

INTRODUCTION: Obesity and type 2 diabetes mellitus (T2DM) significantly increase cardiovascular morbidity and mortality worldwide. Metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective interventions for T2DM and obesity, but comparative evidence on their long-term impact on major adverse cardiovascular events (MACE) and all-cause mortality is lacking. This systematic review and meta-analysis evaluated the efficacy of MBS versus GLP-1 RAs therapy in reducing these outcomes. METHODS: The review was registered in PROSPERO beforehand and carried out following the PRISMA framework. A comprehensive literature search identified randomized controlled trials (RCTs) and observational studies comparing MBS with GLP-1 RAs regimens in adults with obesity and T2DM. The primary outcomes were all-cause mortality and MACE. We used the Cochrane Risk of Bias 2.0 (ROB 2) tool and Newcastle-Ottawa Scale (NOS) to assess the quality of the study. Meta-analytic techniques were used to synthesize effect estimates. RESULTS: Pooled analysis of eligible studies suggested that MBS offered greater reductions in both MACE and all-cause mortality than GLP-1 RAs therapy. The relative risk reduction for MACE was approximately 52% in favor of MBS. Despite notable heterogeneity, sensitivity analyses confirmed result robustness. The overall certainty of evidence was moderate, reflecting variations in populations, interventions, and study designs. CONCLUSION: MBS offers significantly greater cardiovascular protection than GLP-1 RAs therapy in individual with obesity and T2DM, reducing MACE and all-cause mortality. GLP-1 RAs remains an important option, particularly for patients contraindicated for surgery or preferring pharmacotherapy. Further long-term comparative and cost effectiveness studies are needed to inform the clinical decisions.