# Major Adverse Cardiovascular Event Outcomes in Patients With Obesity and Type 2 Diabetes Undergoing Medical Weight Management

## TL;DR

This study compared the effectiveness of medical weight management, surgery, and usual care in reducing cardiovascular risks for people with obesity and diabetes.

## Contribution

The study provides new comparative evidence on cardiovascular outcomes of different weight management approaches in patients with obesity and T2D.

## Key findings

- Medical weight management showed no significant difference in MACE risk compared to usual care.
- Metabolic and bariatric surgery showed a trend toward fewer MACE events compared to usual care.
- No significant difference was found between medical weight management and surgery for MACE outcomes.

## Abstract

Objective: We assessed the impact of medical weight management (MWM; lifestyle modification ± obesity medications) on major adverse cardiovascular events (MACE) compared to metabolic and bariatric surgery (MBS) and usual care (UC).

Methods: We retrospectively analyzed electronic health records of adults with body mass index (BMI) ≥35 kg/m² and type 2 diabetes mellitus (T2D) at an academic health center from 2010 to 2021. The MWM group was propensity score matched on common confounders 1:1 (versus MBS) and 1:5 (versus UC). The primary outcome was a six-component MACE (all-cause mortality, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, and nephropathy).

Results: Among 2,100 patients (300 MWM, 300 MBS, and 1,500 UC), baseline characteristics were similar among groups. During a median 3.2-year follow-up (range 0-11), the adjusted hazard ratio (aHR) for MACE for MWM versus MBS was 1.61 (0.98-2.65, p=0.06); for MBS versus UC, aHR 0.66 (0.43-1.02, p=0.06); and there was no difference in MWM versus UC, aHR 1.07 (0.77-1.49, p=0.68).

Conclusions: No statistically significant differences in MACE risk were found between those receiving MWM versus UC; there was a trend towards fewer MACE events in those receiving MBS. These findings must be validated in future studies, given that more effective weight loss medications (e.g., semaglutide, tirzepatide) were not available.