Bariatric surgery may enhance cardiovascular health in obese NAFLD patients

A new study revealed that bariatric surgery resulted in a nearly 50% reduction in incident cardiovascular disease and composite cardiovascular adverse events in a large cohort of obese patients with BMI >40 kg/m2 and nonalcoholic fatty liver disease compared to those who did not undergo bariatric surgery. The study results were published in the journal JAMA Network Open.  

Nonalcoholic fatty liver disease (NAFLD) is a well-known independent risk factor for CVD and CVD-related death. Although previous research has shown that lifestyle changes such as weight loss and exercise improve steatosis and metabolic markers of dyslipidemia, their success in lowering CVD risk may be limited, possibly due to the level of effort required to achieve significant improvement being difficult to maintain over time.  As the association between bariatric surgery and better CVD outcome in the obese population with a wide range of NAFLD has not been well investigated, researchers conducted a study to assess if bariatric surgery can reduce the risk of future adverse cardiovascular events in obese NAFLD patients. 

Between January 1, 2007, and December 31, 2017, insured patients aged 18-64 with NAFLD and extreme obesity (BMI >40 kg/m2) were identified in the MarketScan Commercial Claims and Encounters database. Patients having past bariatric surgery, excessive alcohol consumption, or previously identified liver illness unrelated to NAFLD were excluded from the trial. Among the remaining cohort, the surgical group included those who had bariatric surgery (sleeve gastrectomy or Roux-en-Y) during the research period, whereas the nonsurgical group included those who did not have bariatric surgery during the study period. Myocardial infarction, heart failure, or stroke were the primary composite outcomes. Ischemic cardiovascular and cerebrovascular events, CVD, and atherosclerosis were included in the secondary composite outcome. Using Cox proportional hazards modeling with inverse probability treatment weighting, bariatric surgery was compared to all outcomes as a time-varying variable.