Assessing the impact of bariatric surgery on cardiovascular risk in type 2 diabetes: a systematic review and meta-analysis using OMICs data

Type 2 diabetes (T2D) is a complex, multifactorial metabolic disorder, and while bariatric surgery has emerged as a promising intervention for obesity-related T2D with significant metabolic benefits, its long-term durability and potential for remission vary among patients. This systematic review and meta-analysis explore how omics modalities-such as genomics, epigenomics, transcriptomics, metabolomics, proteomics, and gut microbiome-can reveal potential biomarkers linked to cardiovascular disease (CVD) of T2D patients who undergo bariatric surgery. Following PRISMA 2020 guidelines, a systematic search in PubMed identified 49 eligible studies. The meta-analysis of eight proteomic biomarkers, showed significant post-surgery improvements in total cholesterol (mean difference (MD) 0.44 (95% CI: 0.06-0.82), p = 0.02), triglycerides (MD 1.00 (0.77-1.24), p < 0.00001), LDL cholesterol (MD 0.27 (0.02, 0.52), p = 0.03), HDL cholesterol (MD -0.22 (-0.30, -0.15), p < 0.00001), hsCRP (MD 0.64 (0.44, 0.84), p < 0.00001), C peptide levels (MD 1.29 (0.96, 1.61), p < 0.0001), and IL-6 (MD 1.84 (0.85, 2.84), p = 0.0003). These findings highlight the value of integrated omics in developing personalized diagnostics, predicting disease risks, and designing targeted therapies. The present study is the first systematic review presenting the omics disciplines that offer a comprehensive view of the effectiveness of bariatric surgery in managing T2D, subsequently reducing the risk of CVD.