What does this research mean for the field?

Metabolic-bariatric surgery significantly reduces the predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk, with no significant differences between sleeve gastrectomy and one-anastomosis gastric bypass over 4 years. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 8, 2026

Comparative effectiveness of sleeve gastrectomy and one-anastomosis gastric bypass on cardiovascular disease risk

Key Result

Metabolic-bariatric surgery reduced 10-year ASCVD risk similarly after sleeve gastrectomy and one-anastomosis gastric bypass over 4 years in 1397 patients.

Key Points

This study aims to compare the effectiveness of sleeve gastrectomy and one-anastomosis gastric bypass on reducing cardiovascular disease risk over ten years.
Prospective observational cohort study design
Participants aged 40-79 years undergoing metabolic-bariatric surgery
ASCVD risk estimated at baseline, 6 months, 12 months, and annually up to 4 years post-op
Regression models used to analyze factors influencing ASCVD risk changes
1397 participants included with an average age of 50.1 years, predominantly female
Both surgical groups showed a significant reduction in predicted ASCVD risk post-op
No significant difference in ASCVD risk reduction between sleeve gastrectomy and one-anastomosis gastric bypass over 4 years
Key factors for risk reduction included baseline risk factors like cholesterol levels and presence of type 2 diabetes

Structured PICO

Does sleeve gastrectomy compared to one-anastomosis gastric bypass improve predicted 10-year ASCVD risk in adults undergoing metabolic-bariatric surgery?

Population

1,397 participants aged 40-79 years who underwent metabolic-bariatric surgery between 2013 and 2023 (mean age 50.1 ± 7.2 years, 87.9% female)

Intervention

Sleeve gastrectomy (SG) (n=952)

Comparator

One-anastomosis gastric bypass (OAGB) (n=445)

Outcome

Predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimated using the ACC/AHA ASCVD Risk Estimator over up to 4 years follow-upsurrogate

Metabolic-bariatric surgery significantly reduces predicted 10-year ASCVD risk, with comparable effectiveness between sleeve gastrectomy and one-anastomosis gastric bypass.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Metabolic-bariatric surgery (MBS) is a transformative intervention that facilitates substantial and sustained weight loss while effectively ameliorating obesity-related comorbidities, particularly cardiovascular disease (CVD). Purpose This study aims to compare the effectiveness of sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) on the predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk. Additionally, it seeks to identify key factors influencing post-operative (Post-Op) changes in ASCVD risk. Methods In this prospective observational cohort study, the 10-year ASCVD risk was estimated using the ACC/AHA ASCVD Risk Estimator at baseline, 6 months and 12 months Post-Op, and annually thereafter for up to 4 years. Participants aged 40-79 years who underwent MBS (SG or OAGB), between 2013 and 2023 were included. Longitudinal changes in ASCVD risk were analysed, and regression models were applied to evaluate the impact of individual and combined factors on risk changes over the maximum follow-up period. Results The study included 1397 participants (mean age 50.1 ± 7.2 years, 87.9% female), with 952 undergoing SG and 445 undergoing OAGB. Participants who underwent OAGB had a higher baseline body mass index (BMI) and more severe diabetes status. After adjusting for potential confounders, the 10-year ASCVD risk significantly reduced Post-Op, with no observed differences between the surgical groups over the 4-year follow-up period. Positive associations with ASCVD risk reduction were identified for baseline risk score, total cholesterol (TC), type 2 diabetes mellitus (T2DM), triglycerides, systolic blood pressure (SBP), fasting plasma glucose (FPG), and estimated glomerular filtration rate (eGFR). Conversely, age, triglyceride-glucose (TyG) index, haemoglobin A1c (HbA1c), male sex, smoking, and high-density lipoprotein cholesterol (HDL-C) demonstrated negative associations with ASCVD risk reduction. Conclusion(s) MBS significantly reduced the predicted 10-year ASCVD risk, with comparable outcomes between SG and OAGB. Key determinants influencing the changes in ASCVD risk included baseline risk score, age, TC, T2DM, TyG index, triglycerides, HbA1c, SBP, sex, FPG, smoking, HDL-C, and eGFR.

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