Bariatric surgery halves adverse CVD events in NAFLD, severely obese patients

In adults with nonalcoholic fatty liver disease (NAFLD) and morbid obesity, undergoing bariatric surgery was associated with a significantly lower risk of serious adverse cardiovascular events than nonsurgical care. rice field.

Specifically, researchers at Rutgers University reported a nearly 50% reduction in the risk of adverse cardiovascular events such as myocardial infarction, heart failure and stroke.The risk of secondary cardiovascular outcomes, such as ischemic or embolic events, was similarly low, they report. JAMA network opened.

“The findings provide evidence in support of bariatric surgery as an effective therapeutic tool to reduce the elevated risk of cardiovascular disease in selected individuals with obesity and NAFLD.” The Center for Disease and Liver Masses said in a statement: From Rutgers“These findings are highly impactful for many reasons.”

The gradual increase in the incidence of NAFLD in the United States is primarily due to steadily rising rates of obesity, metabolic syndrome, and type 2 diabetes. The prevalence of NAFLD increases with BMI, and severe obesity (BMI ≥40 kg/m²). According to this study, it is estimated that 85% of severely obese patients have his NAFLD and 40% have nonalcoholic steatohepatitis (NASH).

Of the severely obese population, it is estimated that 85% have NAFLD and 40% have nonalcoholic steatohepatitis (NASH).

Researchers note that bariatric surgery is already associated with long-term improvement in NAFLD histologic features and reduced CVD risk in people with NAFLD and obesity. physical activity. According to them, not fully explored is the association between bariatric surgery across the spectrum of NAFLD and his CVD.

Their study, a population-based, retrospective cohort study of approximately 87,000 adults, was designed to augment this knowledge base.

For the study cohort, Rustgi and colleagues utilized the MarketScan Commercial Claims and Encounters database from January 2, 2007 to December 31, 2017. A search of his 230 million eligible enrollees in the database returned data for 86,964 adults with his NAFLD, ages 18 to 64. and severe obesity.Included were severe obesity defined according to clinical guidelines as BMI ≥40 kg/m with a minimum of 12 months of continuous enrollment prior to first NAFLD diagnosis (index date)²Among the exclusion criteria were other liver disease, excessive alcohol use, previous bariatric surgery, or CVD outcome of the study prior to the index date.

The outcome of primary interest was the incidence of cardiovascular events, ie, the first occurrence of a primary or secondary combined CVD outcome.

Primary cardiovascular composites included myocardial infarction, heart failure, or ischemic stroke, and broad secondary composites included secondary ischemic cardiac events, transient ischemic attacks, secondary cerebrovascular events, It included either arterial embolism and thrombosis, or atherosclerosis. The researchers used a Cox proportional hazards regression model with inverse probability treatment weighting to analyze associations between bariatric surgery and all outcomes modeled as time-varying.

findings

The mean age of the final cohort of 86,964 adults was 44.3 years and 68.7% were female. 30,300 (34.8%) had bariatric surgery (surgery group) and 56,664 (65.2%) received non-surgical care (non-surgery group). Bariatric surgery included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy, and other types of bariatric surgery. The mean follow-up for all participants was 21.2 months, 29.2 months for patients in the surgery group and 16.8 months for patients in the non-surgery group.

Investigators recorded 2950 major CVD events. Of these, 784 followed a secondary CVD event. At 96 months follow-up, bariatric surgery was associated with a 47% lower cumulative incidence of primary events (surgery 9.7% vs non-surgery 18.3%; aHR, 0.53 [95% CI, 0.48-0.59]). The hazard for primary CVD outcome remained significantly lower in individuals in the surgery group after adjusting for secondary events occurring before the primary outcome (aHR, 0.61; 95% CI, 0.55-0.67).

An analysis of CVD risk found that bariatric surgery was associated with a 49% lower risk of CVD compared with nonsurgical care (aHR, 0.51; 95% CI, 0.48-0.54). The risk of primary combined CVD outcome was reduced by 47% (aHR, 0.53[95%CI048-059)andtheriskofsecondarycombinedCVDoutcomewasreducedby50%(aHR050;95%CI046-053))Comparisonofoperatedvsnon-operatedpersons[95%CI048-059)andtheriskofsecondarycompositeCVDoutcomesdecreasedby50%(aHR050;95%CI046-053)individualswithvswithoutsurgery[95%CI、048-059)減少し、二次複合CVD転帰のリスクは50%減少しました(aHR、050;95%CI、046-053)。)手術を受けた人と手術を受けていない人の比較。[95%CI048-059)andtheriskofsecondarycompositeCVDoutcomesdecreasedby50%(aHR050;95%CI046-053)inindividualswithvswithoutsurgery

The authors note that interventions targeting NAFLD-associated obesity may potentially reduce CVD risk in this population, but acknowledge that there are no drugs approved for this indication. increase. The benefits of lifestyle changes are hard to maintain, they add.

“Bariatric surgery is a more proactive approach than lifestyle changes, but it may be associated with other benefits, such as improved quality of life and reduced long-term health care burden,” Rustgi said. I’m here.

Reference: Elsaid MI, Li Y, Bridges JFP, et al. Association between Bariatric Surgery and Cardiovascular Outcomes in Adults with Severe Obesity and Nonalcoholic Fatty Liver Disease. JAMA network opened. 2022;5(10):e2235003.doi:10.1001/jamanetworkopen.2022.35003