Efficacy of Metabolic and Bariatric Surgery Compared with GLP-1 Receptor Agonist Treatment in Preventing Mortality and Major Adverse Cardiac Events Among Individuals with Obesity and Type 2 Diabetes: A Systematic Review and Meta-analysis

Obesity and type 2 diabetes mellitus (T2DM) significantly increase cardiovascular morbidity and mortality worldwide. Metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective interventions for T2DM and obesity, but comparative evidence on their long-term impact on major adverse cardiovascular events (MACE) and all-cause mortality is lacking. This systematic review and meta-analysis evaluated the efficacy of MBS versus GLP-1 RAs therapy in reducing these outcomes. The review was registered in PROSPERO beforehand and carried out following the PRISMA framework. A comprehensive literature search identified randomized controlled trials (RCTs) and observational studies comparing MBS with GLP-1 RAs regimens in adults with obesity and T2DM. The primary outcomes were all-cause mortality and MACE. We used the Cochrane Risk of Bias 2.0 (ROB 2) tool and Newcastle-Ottawa Scale (NOS) to assess the quality of the study. Meta-analytic techniques were used to synthesize effect estimates. Pooled analysis of eligible studies suggested that MBS offered greater reductions in both MACE and all-cause mortality than GLP-1 RAs therapy. The relative risk reduction for MACE was approximately 52% in favor of MBS. Despite notable heterogeneity, sensitivity analyses confirmed result robustness. The overall certainty of evidence was moderate, reflecting variations in populations, interventions, and study designs. MBS offers significantly greater cardiovascular protection than GLP-1 RAs therapy in individual with obesity and T2DM, reducing MACE and all-cause mortality. GLP-1 RAs remains an important option, particularly for patients contraindicated for surgery or preferring pharmacotherapy. Further long-term comparative and cost effectiveness studies are needed to inform the clinical decisions.