According to findings from a cohort study published in the Journal of the American Medical Association Network Open, bariatric surgery (BS) was correlated with a substantially lower risk of major adverse cardiovascular events (MACE) and all-cause mortality in patients with nonalcoholic fatty liver disease (NAFLD) and obesity.

In this large, population-based, retrospective cohort study, researchers sought to explore the correlation between BS with the occurrence of MACE and all-cause mortality in patients with NAFLD and obesity (BMI ≥35). The researchers gathered data from the TriNetX platform (Cambridge, Massachusetts), a federated multi-institutional health research network that delivers deidentified electronic health records from healthcare organizations in the network.

The primary outcome was to evaluate the prevalence or new onset of MACE categorized as heart failure (HF), composite cardiovascular events, composite cerebrovascular events, and composite coronary artery interventions.

Cox proportional hazards models were employed to estimate hazard ratios (HRs). The researchers compared outcomes among 4,687 adults (average age, 44.8 years; 81.5% women) who underwent BS between January 2005 and December 2021 and 4,687 propensity-matched individuals (average age, 44.7 years; 82.8% women) who did not undergo BS.

The results indicated that after an average follow-up of 5.1 years (BS group) and 4.3 years (non-BS group), among those in the BS group, there was a significantly lesser risk of new-onset of HF (HR 0.60; 95% CI, 0.51-0.70), cardiovascular 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. Likewise, all-cause mortality was substantially lesser in the BS group (HR 0.56; 95% CI, 0.42-0.74). The authors indicated that at follow-up duration of 1, 3, 5, and 7 years, these outcomes were consistent.

A secondary analysis validated the correlation of BS with a decrease in cardiovascular disease outcomes, including risk for new-onset HF (HR 0.4; 95% CI, 0.37-0.45), composite cardiovascular 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 authors wrote, “Our findings strengthen previously reported associations and add novel data to the current literature. BS has already been reported to be associated with improved long-term adverse cardiovascular outcome risk in patients with obesity and diabetes in matched observational studies.”

They also added, “Our analysis adds new data regarding the association of a therapeutic modality with NAFLD outcomes beyond the surrogate endpoints of histologic improvement or regression. The improvement in mortality observed in the BS cohort was previously unreported for any NAFLD subset, to our knowledge, and supported the use of BS as a therapeutic agent to improve clinical outcomes in NAFLD.”

In conclusion, the authors indicated that their findings imply that BS was linked with a lower incidence of MACE and all-cause mortality in patients with NAFLD and obesity. They wrote, “Although our study provides novel information, randomized clinical trials and additional observational studies are needed to corroborate our findings.”

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