Metabolic and Bariatric Surgery: Utilization, Statin Discontinuation, and Cardiovascular Risk Stratification in the Modern Era

Abstract

Background: Bariatric surgery, as a pivotal intervention to treat obesity, has seen dynamic utilization trends over recent years, and the subsequent pharmacological implications, particularly concerning statin discontinuation, hold significance. With the world grappling with the cardiovascular epidemic and its associated mortality, there's an imperative need to understand the cardiovascular outcomes post-bariatric surgery, especially when linked with discontinuation of critical medications like statins. Aims: This dissertation aimed to delineate the trends in bariatric surgery utilization and the corresponding shifts in surgical techniques in the U.S. Furthermore, it sought to understand the patterns and repercussions of statin discontinuation post-surgery, with an emphasis on discerning the risks associated with discontinuing statin therapy, particularly among patients with a history of Atherosclerotic Cardiovascular Disease (ASCVD). Methods: Comprehensive retrospective analyses were conducted utilizing the TriNetX electronic medical records network, spanning the years 2012 to 2021. The trends in bariatric surgeries were examined alongside their procedural variations. In parallel, patients on statin therapy undergoing bariatric surgery were identified, with their subsequent statin discontinuation patterns being analyzed. The consequences of such discontinuations, especially regarding ASCVD events, were also explored, taking into consideration both primary and secondary prevention cohorts. Results: There was a steady upswing in bariatric surgeries until 2018, which saw a decline during 2020 and 2021, coinciding with the COVID-19 pandemic. The surgical landscape depicted a decline in the Roux-en-Y (RYGB) procedure, substituted by an uptake in the sleeve gastrectomy (SG) procedure. Among statin therapy users, 48% of primary prevention and 34.5% of secondary prevention patients discontinued statin therapy within six months post-bariatric surgery. Alarmingly, within a statin therapy discontinuation post bariatric surgery, secondary prevention patients manifested significantly higher ASCVD event rates compared to their primary prevention counterparts. Distinctly, Hispanic/Latino patients exhibited heightened ASCVD risks post-statin discontinuation, as opposed to non-Hispanic/Latino individuals. Conclusion: The trends in bariatric surgery, amidst their shifting preferences, underscore the importance of understanding the aftermath of such surgeries, especially regarding medication discontinuation. The discontinuation of statins post-bariatric surgery, particularly among those with prior ASCVD, poses discernible risks, accentuating the need for individualized, equitable healthcare strategies. Addressing ethnic disparities and ensuring tailored therapeutic approaches based on comprehensive cardiovascular determinants is crucial. Future research endeavors are essential to further finetune these interventions and recommendations.