Gastric Bypass vs Sleeve: Better Protection from Heart Attacks?

A new study in JAMA Surgery adds to the impression that long-term outcomes are better with gastric bypass surgery when compared to gastric sleeve procedures for treating obesity. Specifically researchers found that people who have gastric bypass surgery are better than one third less likely to have heart attacks than those who have a gastric sleeve. The authors tell us this study is important because it gives us insight into the relative effectiveness of these two procedures:

“Patients undergoing gastric bypass had a lower risk of MACE [major adverse cardiovascular events] compared to those undergoing sleeve gastrectomy, suggesting a cardiovascular advantage of gastric bypass over sleeve gastrectomy.”

The insight is even more significant when we consider that more than twice as many people who seek metabolic surgery opt for a gastric sleeve than a bypass procedure.

11 Years of Follow-up

Simone Wildisen and colleagues followed 39,067 patients who received either a gastric bypass or a gastric sleeve for up to 11 years. Median follow-up was 5.1 years and the primary outcome was the occurrence of any of four major adverse cardiovascular events – heart attack, stroke, hospitalization for heart failure, or death.

The rate of this composite outcome was 25% lower in the gastric bypass group and that difference was driven mostly by the one-third reduction in heart attacks.

Let’s be clear. These are important findings because metabolic surgery remains an important option for treating obesity – even with the advent of GLP-1 medicines. The authors explain this succinctly:

“Metabolic bariatric surgery is the most effective and durable treatment for weight loss and improvement of cardiovascular diseases.”

Of course, this was an observational study. So the authors remind us that it does not provide definitive evidence that the difference in outcomes is driven entirely by differences between these two procedures. This is true even though they used advanced statistical methods to reduce the possibility that other factors could be at work in these results.

The Evolving View of Bypass and Sleeve Procedures

Up until 2018, the number of gastric sleeve procedures was growing like gangbusters. But now, long-term outcomes are becoming clearer and seem to favor gastric bypass. So more recent numbers show more growth in bypass procedures.

The new results this week, suggesting cardioprotective benefits for gastric bypass, offer one more reason to favor that procedure. Especially if we take the long view.

Click here for the new study in JAMA Surgery and here for further reporting on it.

Woman Keeping an Apple, painting by Kmetty János / WikiArt

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May 9, 2025