Comparative evidence for the effects of bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP1-RA) on cardiovascular outcomes is limited. Here, in an observational, retrospective cohort study, we compared the incidence of Congestive Heart Failure (CHF) in adults living with obesity and diabetes without history of CHF (primary CHF) treated with BMS versus GLP-1RA. The population cohort comprised members of Clalit Health Services with no prior history of ischemic heart disease, ischemic stroke, or CHF. During the time period of 2008 – 2021, patients who underwent their first BMS were matched 1:1 with patients who initiated treatment with GLP-1RA, based on clinical characteristics. The study included 2,205 matched pairs of patients (64.5% female), followed for a median of 6.6 years and up to 12 years. Primary incidence of CHF occurred in 26 (1.2%) BMS patients and in 90 GLP1-RA patients (4.1%), adjusted HR: 0.43, 95% CI: 0.27-0.68. Further adjustment for weight reduction did not significantly diminish this association, HR adjusted for weight reduction: 0.48, 95% CI 0.28-0.82, indicating that the differential effect was not mediated through the relative advantage of BMS in maximal weight reduction. In this study, BMS was associated with a stronger reduction in primary incidence of CHF compared to treatment with GLP1-RA. With the increasing use of highly potent next-generation GLP1-RAs, further comparative long-term studies are warranted.

减肥代谢手术 (BMS) 和胰高血糖素样肽 1 受体激动剂 (GLP1-RA) 对心血管结局影响的比较证据有限。在这里，在一项观察性、回顾性队列研究中，我们比较了接受 BMS 与 GLP-1RA 治疗的无 CHF 病史（原发性 CHF）的肥胖和糖尿病成人的充血性心力衰竭 (CHF) 发生率。人群队列由 Clalit 健康服务中心的成员组成，之前没有缺血性心脏病、缺血性中风或 CHF 病史。在 2008 年至 2021 年期间，根据临床特征，接受第一次 BMS 的患者与开始接受 GLP-1RA 治疗的患者进行 1:1 匹配。该研究纳入了 2,205 对匹配的患者（64.5% 为女性），随访时间中位数为 6.6 年，最长可达 12 年。 26 名 BMS 患者 (1.2%) 和 90 名 GLP1-RA 患者 (4.1%) 发生了原发性 CHF，调整后 HR：0.43，95% CI：0.27-0.68。体重减轻的进一步调整并没有显着减弱这种关联，体重减轻调整后的 HR：0.48，95% CI 0.28-0.82，表明差异效应不是通过 BMS 在最大体重减轻方面的相对优势来介导的。在这项研究中，与 GLP1-RA 治疗相比，BMS 与 CHF 原发发病率的显着降低相关。随着高效下一代 GLP1-RA 的使用越来越多，有必要进行进一步的长期比较研究。