Major Adverse Cardiovascular Event Outcomes in Patients With Obesity and Type 2 Diabetes Undergoing Medical Weight Management.

OBJECTIVE

We assessed the impact of medical weight management (MWM; lifestyle modification ± obesity medications) on major adverse cardiovascular events (MACE) compared to metabolic and bariatric surgery (MBS) and usual care (UC).

METHODS

We retrospectively analyzed electronic health records of adults with body mass index (BMI) ≥35 kg/m² and type 2 diabetes mellitus (T2D) at an academic health center from 2010 to 2021. The MWM group was propensity score matched on common confounders 1:1 (versus MBS) and 1:5 (versus UC). The primary outcome was a six-component MACE (all-cause mortality, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and nephropathy).

Results

Among 2,100 patients (300 MWM, 300 MBS, and 1,500 UC), baseline characteristics were similar among groups. During a median 3.2-year follow-up (range 0-11), the adjusted hazard ratio (aHR) for MACE for MWM versus MBS was 1.61 (0.98-2.65, p=0.06); for MBS versus UC, aHR 0.66 (0.43-1.02, p=0.06); and there was no difference in MWM versus UC, aHR 1.07 (0.77-1.49, p=0.68).

CONCLUSIONS

No statistically significant differences in MACE risk were found between those receiving MWM versus UC; there was a trend towards fewer MACE events in those receiving MBS. These findings must be validated in future studies, given that more effective weight loss medications (e.g., semaglutide, tirzepatide) were not available.