Abstract 4370759: Bariatric Surgery vs. GLP/GIP Agonists: A Real-World Comparative Analysis of Cardiovascular Outcomes in Over 2 Million Patients.

This retrospective cohort study utilized the TriNetX Research Network, comprising real-time electronic medical records from over 100 healthcare organizations. Adults (≥18 years) treated between 2021 and 2024 were included if they underwent bariatric surgery or received a GLP/GIP agonist (tirzepatide, semaglutide, liraglutide, or dulaglutide). Patients exposed to both interventions were excluded. Propensity score matching (1:1, greedy nearest neighbor) was used to balance covariates between groups. The analytic window spanned from 90 to 1,095 days post-index. Patients with a prior history of each outcome were excluded. Primary outcomes included mortality, atrial fibrillation (Afib), myocardial infarction (MI), heart failure (HF), and stroke. Risk ratios (RRs), 95% confidence intervals (CIs), and p-values were calculated for each endpoint. Results: The final matched cohorts included 135,863 bariatric patients and 2,070,839 GLP/GIP-treated patients. Bariatric surgery was associated with significantly lower risk of mortality (RR 0.561, 95% CI: 0.524–0.600, p < 0.001), Afib (RR 0.892, 95% CI: 0.828–0.960, p = 0.002), MI (RR 0.605, 95% CI: 0.536–0.684, p < 0.001), and HF (RR 0.578, 95% CI: 0.531–0.630, p < 0.001). Stroke risk was also significantly lower (RR 0.863, 95% CI: 0.801–0.930, p < 0.001). Kaplan-Meier survival analyses confirmed improved event-free survival in the bariatric cohort across all outcomes. Notably, hazard ratios mirrored these findings, with mortality HR 0.365 ( p < 0.001), HF HR 0.440 ( p < 0.001), and MI HR 0.553 ( p < 0.001). Conclusion: In this large real-world analysis, bariatric surgery was associated with significantly lower risks of death, arrhythmias, myocardial infarction, heart failure, and stroke compared to GLP/GIP therapy. These results reinforce the profound cardiometabolic benefits of bariatric surgery and highlight its value as a preferred intervention in eligible patients at high cardiovascular risk.