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.

IF 4.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Quality of Care and Clinical Outcomes Pub Date : 2025-01-20 DOI:10.1093/ehjqcco/qcaf001

Arunkumar Krishnan, Omar T Sims, Daniel Teran, Tinsay A Woreta, William R Hutson, Saleh A Alqahtani

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引用次数: 0

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 if 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 the diagnosis of MASLD, obesity (i.e. body mass index [BMI] ≥35 kg/m2), and pre-existing coronary artery disease (CAD) between January 1, 2005, to December 31, 2022, were included. Patients with a BS were compared to 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 (HR = 0.56, 95% 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 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, 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.

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肥胖、代谢功能障碍相关脂肪性肝病和冠状动脉疾病患者的减肥手术和心血管结局：一项基于人群的匹配队列研究

目的：减肥手术（BS）是代谢功能障碍相关脂肪变性肝病（MASLD）和肥胖患者的潜在治疗选择。这些患者发生心血管事件和相关死亡的风险也很大。我们的目的是评估BS是否可以减少主要不良心血管事件（MACE）和死亡率，并提高长期生存率。方法和结果：使用TriNetX数据，纳入了2005年1月1日至2022年12月31日期间诊断为MASLD、肥胖（即体重指数[BMI]≥35 kg/m2）和已有冠状动脉疾病（CAD）的成年患者（bb0 - 18岁）。将BS患者与无BS病史的患者进行比较。主要结局是第1、3、5、7和10年MACE、心力衰竭、脑血管事件和冠状动脉手术或手术的发生率。次要结局是第1、3、5、7和10年的全因死亡率。我们进行了1:1的倾向评分匹配（PSM）、敏感性分析和生存分析。经PSM后，两组共1038例患者。在第1年，BS患者MACE （HR = 0.56, 95% CI, 0.39-0.80）、脑血管疾病（HR = 0.62, 95% CI, 0.46-0.82）和冠状动脉手术（HR = 0.65, 95% CI, 0.42-0.98）的发生率显著降低。同样，在3、5、7和10时，BS患者MACE、心力衰竭、脑血管疾病和冠状动脉手术的发生率显著降低。BS患者3、5、7、10年全因死亡率均显著降低。敏感性分析证实了这些发现。结论：MASLD、肥胖和已存在CAD患者的BS可以显著降低心血管事件复发的风险，并在BS的第一年内显着提高生存率，并且可以长期持续，甚至在BS后10年。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal - Quality of Care and Clinical Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

3.80%

发文量

期刊介绍： European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.