Bariatric surgery lowers risk for any CV outcome among adults with severe obesity, NAFLD
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Adults with nonalcoholic fatty liver disease and severe obesity have a lower risk for cardiovascular disease if they undergo bariatric surgery vs. those who do not have surgery, according to study findings published in JAMA Network Open.
“There was almost a 50% risk reduction in CV outcomes, including myocardial infarction, by losing weight in patients with obesity,” Vinod K. Rustgi, MD, MBA, distinguished professor of medicine, clinical director of hepatology, director of the Center for Liver Diseases and Liver Masses and professor of epidemiology and of pathology and laboratory medicine at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, told Healio. “For those who cannot achieve weight loss through lifestyle modification, bariatric surgery is a more aggressive, but highly effective option.”
Rustgi and colleagues obtained data from the MarketScan Commercial Claims and Encounters database on 86,964 adults aged 18 to 64 years with nonalcoholic fatty liver disease (NAFLD) and severe obesity (68.7% women; mean age, 44.3 years). The cohort was divided into a group that underwent any type of bariatric surgery suggested by the American Society for Metabolic and Bariatric Surgery and a group that did not have surgery. Incidence of CV events were collected from the database. Primary CV outcomes included MI, heart failure and ischemic stroke. Secondary CV outcomes included secondary ischemic heart events, transient ischemic attack, secondary cerebrovascular events, arterial embolism and thrombosis, and atherosclerosis. Data were collected from 2007 to 2017.
Of the cohort, 34.8% underwent bariatric surgery. The surgery group was younger (mean age, 43.3 years vs. 44.9 years; P < .001), had a higher proportion of women (75.9% vs. 64.9%; P < .001) and had a lower percentage of people with a history of smoking (6.2% vs. 9.4%; P < .001) than the nonsurgical group.
The cumulative incidence of incident CV events in the surgical group was lower than the nonsurgical group at 24 months (5% vs. 12.8%), 48 months (10.4% vs. 21.1%), 72 months (15.6% vs. 28.2%) and 96 months (21.6% vs. 35.6%). In an adjusted model, adults who underwent bariatric surgery had a lower risk for any CV event than those who did not undergo surgery (adjusted HR = 0.51; 95% CI, 0.48-0.54).
The risk for primary CV outcomes was reduced for adults who underwent bariatric surgery compared with the nonsurgery group (aHR = 0.53; 95% CI, 0.48-0.59). The bariatric surgery group had a lower risk for MI (aHR = 0.8; 95% CI, 0.63-1), heart failure (aHR = 0.39; 95% CI, 0.34-0.45) and ischemic stroke (aHR = 0.79; 95% CI, 0.66-0.94) than those who did not undergo surgery.
For secondary CV outcomes, adults undergoing bariatric surgery had a lower risk compared with those who did not undergo surgery (aHR = 0.5; 95% CI, 0.46-0.53). The bariatric surgery group had a lower risk for secondary ischemic heart events (aHR = 0.38; 95% CI, 0.34-0.42), secondary cerebrovascular events (aHR = 0.6; 95% CI, 0.51-0.7), atherosclerosis (aHR = 0.7; 95% CI, 0.61-0.81), transient ischemic attack (aHR = 0.72; 95% CI, 0.59-0.89) and arterial embolism and thrombosis (aHR = 0.61; 95% CI, 0.4-0.91) than the nonsurgical group.
“The findings provide evidence in support of bariatric surgery as an effective therapeutic tool to lower elevated CVD risk for select individuals with obesity and NAFLD,” the researchers wrote. “Although bariatric surgery is a more aggressive approach than lifestyle modifications, it may be associated with other benefits, such as improved quality of life and decreased long-term health care burden.”
For more information:
Vinod K. Rustgi, MD, MBA, can be reached at vr262@rwjms.rutgers.edu.
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