BACKGROUND: This study compared cardiovascular outcomes associated with metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in individuals with obesity. METHODS: The TriNetX network was used to compare cardiovascular risk in adult patients with BMI ≥35 who underwent MBS with those who received GLP-1 RA therapy for ≥2 years. Primary outcome was cardiovascular disease (CVD), a composite of incident heart failure (HF), coronary artery disease (CAD), and cerebrovascular disease. Patient follow-up lasted up to 10 years. RESULTS: MBS was associated with lower hazard of the primary composite outcome of CVD (HR, 0.54, 95 % CI, 0.49-0.60), and the secondary outcomes of incident HF (HR, 0.45, 95 % CI, 0.39-0.52), CAD (HR, 0.54, 95 % CI, 0.45-0.66), and cerebrovascular disease (HR, 0.64, 95 % CI, 0.53-0.77). CONCLUSIONS: A lower risk of adverse cardiovascular outcomes was noted after MBS compared with GLP-1 RA therapy in patients with obesity.