Bariatric surgery may lower risk for cardiovascular events, mortality in NAFLD, obesity
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Key takeaways:
- Bariatric surgery was associated with a lower risk for major cardiovascular events and mortality in patients with NAFLD and obesity.
- Results were consistent at 1, 3, 5 and 7 years of follow-up.
Bariatric surgery was linked to a decreased risk for major adverse cardiovascular events and all-cause mortality among patients with nonalcoholic fatty liver disease and obesity, according to results in JAMA Network Open.
“Bariatric surgery (BS) may be indicated in patients with obesity and NAFLD to achieve and maintain the degree of weight loss associated with therapeutic outcomes,” Arunkumar Krishnan, MBBS, from the section of gastroenterology and hepatology at West Virginia University School of Medicine, and colleagues wrote. “However, there is a paucity of data on the impact of BS specifically for patients with NAFLD, and the outcomes of BS in patients with obesity cannot be directly extrapolated for patients with NAFLD.”
They continued, “The pathophysiology behind the association of NAFLD with cardiovascular disease (CVD) is not completely understood, and CVD development in NAFLD may involve other pathways besides obesity and insulin resistance alone.”
In a population-based, retrospective cohort study, Krishnan and colleagues examined the link between BS and the incidence of major adverse CV events and all-cause mortality in patients with NAFLD and obesity (BMI ≥ 35). Researchers compared outcomes among 4,687 adults (mean age, 44.8 years; 81.5% women) who underwent BS between January 2005 and December 2021 and 4,687 propensity-matched individuals (mean age, 44.7 years; 82.8% women) who did not undergo BS.
After a mean follow-up of 5.1 years (BS group) and 4.3 years (non-BS group), researchers reported a “significantly lower risk” for new-onset heart failure (HR = 0.6; 95% CI, 0.51-0.7), composite CV events (HR = 0.53; 95% CI, 0.44-0.65), composite cerebrovascular events (HR = 0.59; 95% CI, 0.51-0.69) and composite coronary artery interventions (HR = 0.47; 95% CI, 0.35-0.63) among patients in the BS group vs. patients in the non-BS group. All-cause mortality also was lower in the BS group (HR = 0.56; 95% CI, 0.42-0.74), with consistent results at 1, 3, 5 and 7 years of follow-up.
A secondary analysis confirmed the association of BS with a decline in CVD outcomes, including risk for new-onset heart failure (HR = 0.4; 95% CI, 0.37-0.45), composite CV events (HR = 0.52; 95% CI, 0.46-0.6), composite cerebrovascular events (HR = 0.54; 95% CI, 0.49-0.6), composite coronary artery interventions or surgical treatments (HR = 0.44; 95% CI, 0.36-0.53) and mortality (HR = 0.41; 95% CI, 0.35-0.47).
“The findings of this cohort study suggest that BS was associated with a lower incidence of major adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity,” Krishnan and colleagues wrote. “Although our study provides novel information, randomized clinical trials and additional observational studies are needed to corroborate our findings.”
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