Bariatric surgery—a procedure that alter the digestive system to help people lose weight—was strongly linked to a lower risk for cardiovascular events and death in people with obesity and non-alcoholic fatty liver disease (NAFLD), according to study findings published in JAMA Network Open.
Arising from the accumulation of fat in the liver, NAFLD and its more severe form, non-alcoholic steatohepatitis (NASH), are responsible for a growing proportion of advanced liver disease worldwide. Over time, the buildup of fat in the liver can lead to fibrosis, cirrhosis and liver cancer. Associated with obesity and diabetes, fatty liver disease is increasingly recognized as a metabolic disorder. With no effective approved therapies, management depends on lifestyle changes such as diet, exercise and weight loss.
Bariatric surgery, such as removing or bypassing part of the stomach, changes how the gut digests and absorbs food. While such surgery is known to decrease the likelihood of heart disease in people with obesity in the general population, its impact on people with NAFLD is not well understood.
Shailendra Singh, MD, of West Virginia University School of Medicine, and colleagues explored the potential link between bariatric surgery and the occurrence of heart-related events and all-cause mortality in people with obesity and fatty liver disease.
The study included 152,394 adult participants with NAFLD and a body mass index of 35 or higher who underwent bariatric surgery between January 2005 and December 2021. The participants did not yet have liver cirrhosis. Of these, 4,693 people received bariatric surgery and 147,701 people did not undergo surgery.
The researchers matched 4,687 people who underwent bariatric surgery with 4,687 people who did not receive surgery on the basis of age, other demographic characteristics, comorbidities and medication use. Among the matched patients, 82% were women, and the mean age was about 45 years.
The researchers found that bariatric surgery was linked to a significantly lower risk for major cardiovascular and cerebrovascular events, including new-onset heart failure, unstable angina (chest pains), heart attacks, strokes and revascularization procedures. People who received bariatric surgery had about half the risk of such events compared with those who did not undergo surgery.
Bariatric surgery was also associated with a lower risk of death from any cause: All-cause mortality was reduced by about half for those who underwent surgery.
Repeated follow-up at one, three, five and seven years after surgery revealed that these benefits persisted over time.
“These findings suggest that bariatric surgery was associated with a substantially lower risk of incidents of major adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity,” the study authors concluded.