Bariatric surgery provides cardioprotection in patients with severe obesity, NAFLD

Patients with severe obesity and nonalcoholic fatty liver disease (NAFLD) appear to benefit from bariatric surgery, which significantly reduces the risk of cardiovascular disease (CVD), a study has found.

The large, population-based retrospective cohort study used data from the MarketScan Commercial Claims and Encounters database and included insured adults aged 18–64 years with NAFLD and body mass index of ≥40 kg/m² who were CVD-free.

A total of 86,964 adults (mean age 44.3 years, 68.7 percent female) were included in the analysis. Of these, 30,300 (34.8 percent) underwent bariatric surgery (eg, Roux-en-Y gastric bypass, sleeve gastrectomy, and other bariatric procedures) and 56,664 (65.2 percent) received nonsurgical care. All baseline characteristics were balanced after applying inverse probability treatment weighting.

The primary endpoint was the incidence of cardiovascular events (primary or secondary composite CVD outcomes). The primary composite endpoint included myocardial infarction, heart failure, or ischaemic stroke. The secondary composite outcome included secondary ischaemic heart events, transient ischaemic attack, secondary cerebrovascular events, arterial embolism and thrombosis, or atherosclerosis.

Incident cardiovascular events occurred in 1,568 individuals in the surgical group and in 7,215 individuals in the nonsurgical group (incidence rate difference, 4.8 per 100 person-years). Bariatric surgery conferred a 49-percent protection against risk the of CVD as compared with nonsurgical care (adjusted hazard ratio [aHR], 0.51, 95 percent confidence interval [CI], 0.48–0.54).

Bariatric surgery also yielded a protective effect on the risk of primary composite CVD outcomes (aHR, 0.53, 95 percent CI, 0.48–0.59) and that of secondary composite CVD outcomes (aHR, 0.50, 95 percent CI, 0.46–0.53).