University of Oulu

Kauppila JH, Markar S, Santoni G, Holmberg D, Lagergren J. Temporal Changes in Obesity-Related Medication After Bariatric Surgery vs No Surgery for Obesity. JAMA Surg. 2023;158(8):817–823. doi:10.1001/jamasurg.2023.0252

Temporal changes in obesity-related medication after bariatric surgery vs no surgery for obesity

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Author: Kauppila, Joonas H.1,2; Markar, Sheraz1,3; Santoni, Giola1;
Organizations: 1Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
2Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
3Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
4School of Cancer and Pharmaceutical Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, England
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: American Medical Association, 2023
Publish Date: 2023-11-06


Importance: Bariatric surgery can resolve hyperlipidemia, cardiovascular disease, and diabetes, but the long-term postoperative trajectories of medications for these conditions are unknown.

Objective: To clarify the long-term use of lipid-lowering, cardiovascular, and antidiabetic medication after bariatric surgery compared with no surgery for morbid obesity.

Design, Setting, and Participants: This population-based cohort study took place in Sweden (2005–2020) and Finland (1995–2018) and included individuals diagnosed with obesity. Analysis took place between July 2021 and January 2022.

Exposures: Bariatric surgery (gastric bypass or sleeve gastrectomy) patients using lipid-lowering, cardiovascular, or antidiabetic medication were compared with 5 times as many control patients with an obesity diagnosis treated with no surgery, matched for country, age, sex, calendar year, and medication use.

Main Outcomes and Measures: Proportions with 95% CIs of lipid-lowering, cardiovascular, or antidiabetic medication.

Results: A total of 26 396 patients underwent bariatric surgery (with gastric bypass or sleeve gastrectomy) (17 521 [66.4%] women; median [IQR] age, 50 [43–56] years) and 131 980 matched control patients (87 605 [66.4%%] women; median [IQR] age, 50 [43–56] years) were included. The proportion of lipid-lowering medication after bariatric surgery decreased from 20.3% (95% CI, 20.2%-20.5%) at baseline to 12.9% (95% CI, 12.7%-13.0%) after 2 years and 17.6% (95% CI, 13.3%-21.8%) after 15 years, while it increased in the no surgery group from 21.0% (95% CI, 20.9%-21.1%) at baseline to 44.6% (95% CI, 41.7%-47.5%) after 15 years. Cardiovascular medications were used by 60.2% (95% CI, 60.0%-60.5%) of bariatric surgery patients at baseline, decreased to 43.2% (95% CI, 42.9%-43.4%) after 2 years, and increased to 74.6% (95% CI, 65.8%-83.4%) after 15 years, while it increased in the no surgery group from 54.4% (95% CI, 54.3%-54.5%) at baseline to 83.3% (95% CI, 79.3%-87.3%) after 15 years. Antidiabetic medications were used by 27.7% (95% CI, 27.6%-27.9%) in the bariatric surgery group at baseline, decreased to 10.0% (95% CI, 9.9%-10.2%) after 2 years, and increased to 23.5% (95% CI, 18.5%-28.5%) after 15 years, while it increased in the no surgery group from 27.7% (95% CI, 27.6%-27.7%) at baseline to 54.2% (95% CI, 51.0%-57.5%) after 15 years.

Conclusions and Relevance: In this study, undergoing bariatric surgery was associated with a substantial and long-lasting reduction in the use of lipid-lowering and antidiabetic medications compared with no surgery for obesity, while for cardiovascular medications this reduction was only transient.

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Series: JAMA surgery
ISSN: 2168-6254
ISSN-E: 2168-6262
ISSN-L: 2168-6254
Volume: 158
Issue: 8
Pages: 817 - 823
DOI: 10.1001/jamasurg.2023.0252
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Dr Lagergren reported financial support from the Swedish Research Council for the submitted work, and Dr Holmberg reported financial support from the Swedish Society of Medicine.
Copyright information: © 2023 Kauppila JH et al. JAMA Surgery. This is an open access article distributed under the terms of the CC-BY License.