Bariatric surgery and cardiovascular outcomes in patients with obesity, metabolic dysfunction-associated steatotic liver disease, and coronary artery disease: a population-based matched cohort study

Abstract

Aims: Bariatric surgery (BS) is a potential treatment option for patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity. These patients are also at substantial risk of developing cardiovascular events and associated mortality. We aimed to assess whether BS could reduce major adverse cardiovascular events (MACE) and mortality and improve long-term survival.

Methods and results: Using the TriNetX data, adult patients (>18 years) with a diagnosis of MASLD, obesity (i.e. body mass index ≥35 kg/m2), and pre-existing coronary artery disease (CAD) between 1 January 2005 and 31 December 2022 were included. Patients with a BS were compared with those with no history of BS. Primary outcomes were the incidence of MACE, heart failure, cerebrovascular events, and coronary artery procedures or surgeries at years 1, 3, 5, 7, and 10. The secondary outcome was all-cause mortality at years 1, 3, 5, 7, and 10. We performed 1:1 propensity score matching (PSM), sensitivity analysis, and survival analysis. After PSM, both groups had a total of 1038 patients. At year 1, BS patients had a significantly lower incidence of MACE [hazard ratio (HR) = 0.56; 95% confidence interval (CI), 0.39-0.80], cerebrovascular disease (HR = 0.62; 95% CI, 0.46-0.82), and coronary artery procedures and surgeries (HR = 0.65; 95% CI, 0.42-0.98). Similarly, at years 3, 5, 7, and 10, BS patients had a significantly lower incidence of MACE, heart failure, cerebrovascular disease, and coronary artery procedures and surgeries. BS patients had significantly lower 3-, 5-, 7-, and 10-year all-cause mortality. Sensitivity analysis confirmed these findings.

Conclusions: BS in patients with MASLD, obesity, and pre-existing CAD can considerably reduce the risk of recurring cardiovascular events and markedly improve survival immediately within the first year of BS and can persist long-term, even a decade after BS.

Keywords: Bariatric surgery; Cardiovascular; MASLD; Mortality; Risk profile.