Cardiovascular Outcomes and Mortality After Bariatric Surgery in Patients With Nonalcoholic Fatty Liver Disease and Obesity
1. In this retrospective cohort study, patients with obesity and non-alcohol-related fatty liver disease (NAFLD) who received a bariatric surgery (BS) had a significantly lower risk of major adverse cardiovascular outcomes than patients who did not receive BS.
2. Patients with obesity and NAFLD who received bariatric surgery had a significantly lower all-cause mortality than patients with obesity and NAFLD who did not receive bariatric surgery.
Evidence Rating Level: 2 (Good)
Non-alcohol-related fatty liver disease (NAFLD) is a common cause of liver disorders, considered to be a hepatic manifestation of metabolic disorders including obesity, insulin resistance, type 2 diabetes, dyslipidemia, and hypertension. Previous research suggests that NAFLD is associated with a significantly higher risk of all-cause mortality, with the leading cause of death being cardiovascular diseases (CVDs). Bariatric surgery (BS) is an efficient weight-loss intervention in patients with obesity and may be indicated in patients with obesity and NAFLD to maintain weight loss. However, there is a paucity of data surrounding the impact of BS specifically on cardiovascular outcomes in patients with NAFLD. Thus, this retrospective cohort study aimed to study the association of BS with major adverse cardiovascular events and all-cause mortality in patients with NAFLD. Eligible patients were identified from January 2005 to December 2021 and divided into two groups – those who underwent BS and those who did not undergo BS – and were matched to each other using 1:1 propensity score matching (PSM). The primary outcome studied was the incidence of major adverse cardiovascular events, including new onset heart failure (HF), composite cardiovascular events, composite cerebrovascular events, and composite coronary artery interventions. In total, 4,687 patients were included in each group after PSM. The BS group was found to have a significantly lower risk of new onset of HF (HR, 0.60; 95% CI, 0.51-0.70), composite cardiovascular 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) compared with the non-BS group. Furthermore, all-cause mortality was significantly lower in the BS group than in the non-BS group (HR, 0.56; 95% CI, 0.42-0.74). When further stratified, risks of 1-, 3-, 5-, and 7-year all-cause mortality were significantly lower in the BS group than the matched non-BS controls. Overall, the findings from this study suggest that BS is associated with improved long-term adverse cardiovascular outcomes in patients with obesity and NAFLD. A major limitation of this study was the nature of the data collected from electronic health records, which are susceptible to errors in coding or data entry. This study is an important step toward further research in mitigating adverse cardiovascular outcomes in patients with NAFLD.
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