A recent large clinical study published in the peer-reviewed journal Annals of Surgery compared two of the most effective modern obesity treatments, metabolic and bariatric surgery and GLP-1 receptor agonist therapy, focusing specifically on their impact on cardiovascular risk over one year. The research offers important insight into how these treatments differ in improving both short-term and long-term heart health risk profiles in adults living with obesity.
Obesity is strongly linked to cardiovascular disease through multiple pathways including inflammation, insulin resistance, high blood pressure, and abnormal cholesterol levels. Because of this, reducing weight and improving metabolic health is one of the most effective ways to lower the risk of atherosclerotic cardiovascular disease (ASCVD), which includes heart attack and stroke.
Two major treatment options now dominate clinical care for obesity:
Metabolic and bariatric surgery (MBS), which includes procedures that physically alter the digestive system to promote weight loss and metabolic improvements.
GLP-1 receptor agonist therapy (GLP-1RA), a class of medications that improve appetite control, blood sugar regulation, and weight reduction.
While both approaches are widely used, direct comparisons of their long term cardiovascular benefits in real world settings have been limited. This study aimed to fill that gap.
The researchers conducted a retrospective cohort study using electronic health records from a large tertiary healthcare system in the United States. Adults included in the study had a body mass index of 30 kg/m² or higher and either underwent bariatric surgery or started GLP-1 receptor agonist therapy between 2020 and 2023.
A total of 812 patients were analyzed. Among them, 579 underwent metabolic and bariatric surgery and 233 were treated with GLP-1 medications. Patients were followed for 12 months after treatment initiation.
At baseline, the GLP-1 group tended to be older and had a higher predicted cardiovascular risk, which is an important factor when interpreting the results.
The primary outcomes focused on changes in estimated 10 year ASCVD risk and lifetime ASCVD risk. These are clinical models used to predict the likelihood of cardiovascular events based on risk factors such as cholesterol, blood pressure, age, and smoking status.
Secondary outcomes included:
Body weight reduction
Blood pressure changes
Cholesterol and lipid profile improvements
These measures help provide a broader understanding of cardiometabolic health beyond just cardiovascular risk scores.
Both treatment approaches produced modest improvements in estimated 10 year cardiovascular risk. The difference between the groups was not statistically significant.
MBS group: −0.8% change
GLP-1 group: −1.1% change
P value: .36
This suggests that in the short term, both interventions perform similarly in reducing near term cardiovascular risk estimates.
A much clearer difference emerged when looking at lifetime cardiovascular risk.
MBS group: −8.6% reduction
GLP-1 group: −1.7% reduction
P value: less than .001
This indicates that metabolic and bariatric surgery provides a substantially greater long-term reduction in predicted cardiovascular risk compared with medication alone.
Weight reduction was significantly higher in the surgical group.
MBS group: −27.8% total body weight loss
GLP-1 group: −11.1% total body weight loss
P value: less than .001
Weight loss is one of the strongest drivers of improved metabolic and cardiovascular outcomes, which likely explains much of the difference in lifetime risk reduction.
The study also found more favorable lipid changes in the surgery group, including:
Greater reductions in low density lipoprotein cholesterol
Greater increases in high density lipoprotein cholesterol
These changes are important because cholesterol balance is a major contributor to plaque buildup in arteries.
Even after adjusting for baseline differences such as body mass index and cardiovascular risk, metabolic and bariatric surgery remained independently associated with greater reductions in lifetime cardiovascular risk.
Statistical result: β −6.92
95% confidence interval: −9.22 to −4.62
This strengthens the conclusion that the observed differences are not solely due to baseline patient characteristics.
The findings suggest that both metabolic surgery and GLP-1 therapy are effective tools for improving cardiovascular health in people with obesity. However, they appear to work at different levels of intensity and long-term impact.
GLP-1 medications provide meaningful improvements and are less invasive, making them an important option for many patients.
Bariatric surgery produces more substantial and sustained metabolic changes, leading to greater reductions in long-term cardiovascular risk and more pronounced weight loss.
These results support a treatment approach that considers both patient preference and clinical severity, rather than a one-size-fits-all strategy.
This research is valuable because it uses real-world clinical data rather than tightly controlled trial conditions. This reflects how these treatments perform in everyday healthcare settings.
It also directly compares two of the most powerful obesity treatments currently available, helping clinicians better understand their relative benefits for long-term heart health.
Like all retrospective studies, this research has limitations. It cannot prove direct causation, only association. Treatment groups were not randomized, which means baseline differences may influence outcomes even after statistical adjustment. Additionally, follow-up was limited to one year, so longer-term comparative effects remain uncertain.
In summary, this large cohort study published in Annals of Surgery shows that both metabolic and bariatric surgery and GLP-1 receptor agonist therapy improve cardiovascular risk in adults with obesity. However, bariatric surgery was associated with significantly greater reductions in lifetime cardiovascular risk, stronger weight loss, and more favorable lipid changes over a 12 month period.
These findings highlight the complementary roles of surgery and medication in obesity treatment and underscore the importance of personalized care strategies for long-term cardiovascular prevention.
Source: Ghusn W. et al., Metabolic and Bariatric Surgery vs Glucagon-like peptide-1 Receptor Agonist Therapy, Annals of Surgery, 2026.
Disclaimer: This article is a rewritten educational summary based on published research. It is not medical advice. Clinical decisions should always be made in consultation with qualified healthcare professionals.
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