Surgery vs. GLP-1 Agonists: Which Better Improves Heart Health Risks?

Obesity and its associated cardiometabolic diseases, such as type 2 diabetes, hypertension, and dyslipidemia, pose significant global health challenges. Both metabolic and bariatric surgery and glucagon-like peptide-1 (GLP-1) receptor agonist therapy have proven highly effective in achieving substantial weight loss and improving these risk factors. However, a direct, head-to-head comparison of their long-term efficacy in improving overall cardiometabolic risk profiles has been less comprehensively studied, leaving a gap in understanding which intervention offers superior benefits for patients with severe obesity and related comorbidities.

The study revealed that while both interventions significantly improved cardiometabolic risk factors, metabolic and bariatric surgery generally demonstrated superior outcomes. Patients undergoing surgery achieved a mean total body weight loss of 31.5%, significantly higher than the 16.2% observed in the GLP-1 agonist group (p<0.001). Diabetes remission rates were also markedly different, with 68% of surgical patients achieving remission compared to 39% in the GLP-1 group (p<0.001). Metabolic and bariatric surgery resulted in a 2.3-fold higher likelihood of achieving remission from type 2 diabetes and a 1.8-fold higher likelihood of hypertension remission compared to GLP-1 receptor agonist therapy over the 2-year period. Furthermore, surgical patients showed a 48% reduction in the need for antihypertensive medications, versus a 22% reduction in the GLP-1 group. Both groups experienced significant improvements in lipid profiles, though surgery led to a 25% greater reduction in triglycerides and a 15% greater increase in HDL cholesterol compared to GLP-1 agonists.