Bariatric surgery lowers cardiovascular disease risk

Adults with severe obesity and non-alcoholic fatty liver disease (NAFLD) who underwent bariatric surgery appeared to have a lower cardiovascular disease (CVD) risk than those who received non-surgical care.

Figure 1: Individuals who received nonsurgical care (n=58,356) and individuals with surgical care (n=28,608) experienced 7,215 and 1,568 incidences of CVEs (A), 2,401 and 549 incidences of primary composite CVD outcome (B), and 5,424 and 1,191 incidences of secondary composite CVD outcome (C), respectively. Bariatric surgery status was modelled as a time-varying variable. Survival estimates were obtained using the Simon-Makuch method. The Mantel and Byar test for survival comparisons of data with a time-varying covariate had p<0.001 for differences between surgical and nonsurgical groups in all panels (Credit: JAMA Network Open (2022). DOI: 10.1001/jamanetworkopen.2022.35003)

Reporting their results in the paper, ‘Association of Bariatric Surgery With Cardiovascular Outcomes in Adults With Severe Obesity and Nonalcoholic Fatty Liver Disease‘, published in JAMA Network Open, the Rutgers team, along with collaborators from Ohio State University, reported that patients undergoing bariatric surgery were nearly 50% less likely to develop adverse cardiovascular events such as heart attacks, angina or strokes.

"The findings provide evidence in support of bariatric surgery as an effective therapeutic tool to lower elevated risk of cardiovascular disease for select individuals with obesity and NAFLD," said Dr Vinod K Rustgi, Distinguished Professor of Medicine, clinical director of Hepatology and director of the Center for Liver Diseases and Liver Masses at Rutgers Robert Wood Johnson Medical School. "These finding are tremendously impactful for many reasons."

In the study, researchers analysed outcomes data, using the MarketScan Commercial Claims and Encounters medical insurance database, from 2007 to 2017. Of 230 million covered individuals, 86,964 adults between the ages of 18 and 64 who had obesity and NAFLD were identified. Of those, 68% of the study group were female, 35% underwent bariatric surgery and 65% received nonsurgical care.

The study sample included 11,371 RYGBs, 10,404 sleeve gastrectomies, and 8,525 other bariatric surgeries. In the surgical group, 1,568 individuals experienced incident cardiovascular events compared with 7,215 individuals in the non-surgical group (incidence rate difference, 4.8 [95% CI, 4.5-5.0] per 100 person-years). At the end of the study, bariatric surgery was associated with a 49% lower risk of CVD (adjusted hazard ratio [aHR], 0.51; 95% CI, 0.48-0.54) compared with nonsurgical care. The risk of primary composite CVD outcomes was reduced by 47% (aHR, 0.53 [95% CI, 0.48-0.59), and the risk of secondary composite CVD outcomes decreased by 50% (aHR, 0.50; 95% CI, 0.46-0.53) in individuals with vs without surgery.

In the surgical group, the cumulative incidences of CVEs were 5.0% at 24 months, 10.4% at 48 months, 15.6% at 72 months, and 21.6% at 96 months (Figure 1). In the nonsurgical group, the cumulative incidences of CVEs were 12.8% at 24 months, 21.1% at 48 months, 28.2% at 72 months and 35.6% at 96 months.

"Although bariatric surgery is a more aggressive approach than lifestyle modifications, it may be associated with other benefits, such as improved quality of life and decreased long-term health care burden," Rustgi said.

Other Rutgers physicians and statisticians in the study included You Li, and Carlos Minacapelli, both in the Division of Gastroenterology and Hepatology at Rutgers Robert Wood Johnson Medical School. Mohamed Elsaid, who worked with this team while obtaining his PhD at Rutgers, is now on faculty at Ohio State.

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