Comparative effectiveness of gastric bypass and sleeve gastrectomy on predicted 10-year risk of cardiovascular disease 5 years after surgery

•The Effectiveness of Gastric Bypass vs. Gastric Sleeve for Cardiovascular Disease (ENGAGE CVD) study compared the effectiveness of vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) operations for reduction of the American College of Cardiology (ACA) and the American Heart Association (AHA) predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk 5 years after surgery.•Patients (2,771 RYGB and 6,256 VSG) were primarily women (80.6%), Hispanic or non-Hispanic Black (63.7%), were 46±10 years old, with a BMI of 43.40±6.5 kg/m2. The predicted 10-year ASCVD risk at surgery was 4.1% for VSG and 5.1% for RYGB, decreasing to 2.6% for VSG and 2.8% for RYGB 1-year postoperatively. By 5 years after surgery, patients remained with relatively low risk levels (3.0% for VSG and 3.3% for RYGB) and there were no significant differences in predicted 10-year ASCVD risk between VSG and RYGB at any time.•For both operations, the prevalence of smoking began to increase immediately following surgery (p<.001). However, all other indicators used for the predicted 10-year ASCVD risk score significantly improved over time (p<.001).•Our findings suggest RYGB and VSG provide similar benefits for 10-year risk of cardiovascular disease. Literature reporting significant differences between VSG and RYGB in 10-year ASCVD risk may be a result of residual confounding.