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Bariatric Surgery Outcomes in Nonalcoholic Fatty Liver Disease and Obesity
Quick Takes
- Bariatric surgery (BS) was associated with decreased risk of MACE and all-cause mortality in patients with nonalcoholic fatty liver disease (NAFLD) and obesity.
- Patients with NAFLD constitute a higher CVD–risk cohort, and it is likely that the CVD risk reduction in this cohort by BS is secondary to obesity-related CVD risk mitigation.
- Given limitations of the current analysis, additional randomized clinical trials and prospective studies are needed to validate these findings.
Study Questions:
What is the association of bariatric surgery (BS) with the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in patients with nonalcoholic fatty liver disease (NAFLD) and obesity?
Methods:
The investigators analyzed a large, population-based, retrospective cohort using data from the TriNetX platform. Adult patients with a body mass index of ≥35 kg/m2 and NAFLD (without cirrhosis) who underwent BS between January 1, 2005, and December 31, 2021, were included. Patients in the BS group were matched with patients who did not undergo surgery (non-BS group) according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. Patient follow-up ended on August 31, 2022, and data were analyzed in September 2022. The primary outcomes were defined as the first incidence of new-onset heart failure (HF), composite of cardiovascular (CV) events (unstable angina, myocardial infarction [MI], or revascularization, including percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]), composite of cerebrovascular disease (ischemic or hemorrhagic stroke, cerebral infarction, transient ischemic attack, carotid intervention, or surgery), and a composite of coronary artery procedures or surgeries (coronary stenting, PCI, or CABG). Cox proportional hazards models were used to estimate hazard ratios (HRs).
Results:
Of 152,394 eligible adults, 4,693 individuals underwent BS; 4,687 patients who underwent BS (mean [SD] age, 44.8 [11.6] years; 3,822 [81.5%] female) were matched with 4,687 individuals (mean [SD] age, 44.7 [13.2] years; 3,883 [82.8%] years) who did not undergo BS. The BS group had significantly lower risk of new-onset HF (HR, 0.60; 95% CI, 0.51-0.70), CV events (HR, 0.53; 95% CI, 0.44-0.65), cerebrovascular events (HR, 0.59; 95% CI, 0.51-0.69), and coronary artery interventions (HR, 0.47; 95% CI, 0.35-0.63) compared with the non-BS group. Similarly, all-cause mortality was substantially lower in the BS group (HR, 0.56; 95% CI, 0.42-0.74). These outcomes were consistent at follow-up duration of 1, 3, 5, and 7 years.
Conclusions:
The authors report that BS was significantly associated with lower risk of MACE and all-cause mortality in patients with NAFLD and obesity.
Perspective:
This study reports that BS was associated with a decreased risk of MACE; new-onset HF; CV events, such as unstable angina, MI, cerebrovascular events; coronary artery interventions; and mortality. Patients with NAFLD constitute a higher CVD–risk cohort, and it is possible that the CVD risk reduction in this cohort by BS is secondary to obesity-related CVD risk mitigation without significant reduction in the obesity-independent CVD risk posed by NAFLD. Of note, given limitations of the current analysis including misclassification and incomplete documentation, additional randomized clinical trials and prospective studies are needed to validate these findings.
Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Vascular Medicine
Keywords: Angina, Unstable, Bariatrics, Bariatric Surgery, Body Mass Index, Cerebrovascular Disorders, Coronary Artery Bypass, Heart Failure, Ischemic Attack, Transient, Myocardial Infarction, Myocardial Revascularization, Non-alcoholic Fatty Liver Disease, Obesity, Percutaneous Coronary Intervention, Primary Prevention, Risk, Risk Reduction Behavior, Stents, Stroke
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