Krishnan Arunkumar, Sims Omar T, Teran Daniel, Woreta Tinsay A, Hutson William R, Alqahtani Saleh A
Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.
Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, NC, USA.
Eur Heart J Qual Care Clin Outcomes. 2025 Jan 20. doi: 10.1093/ehjqcco/qcaf001.
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.
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.
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.
减肥手术（BS）是代谢功能障碍相关脂肪性肝病（MASLD）和肥胖患者的一种潜在治疗选择。这些患者发生心血管事件及相关死亡率的风险也很高。我们旨在评估减肥手术是否能降低主要不良心血管事件（MACE）和死亡率，并提高长期生存率。
利用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]≥35kg/m²）且患有冠状动脉疾病（CAD）的成年患者（>18岁）。将接受减肥手术的患者与无减肥手术史的患者进行比较。主要结局是1、3、5、7和10年时MACE、心力衰竭、脑血管事件以及冠状动脉手术或操作的发生率。次要结局是1、3、5、7和10年时的全因死亡率。我们进行了1:1倾向评分匹配（PSM）、敏感性分析和生存分析。PSM后，两组各有1038例患者。在第1年，减肥手术患者的MACE（HR = 0.56，95%CI，0.39 - 0.80）、脑血管疾病（HR = 0.62，95%CI，0.46 - 0.82）以及冠状动脉手术和操作（HR = 0.65，95%CI，0.42 - 0.98）的发生率显著较低。同样，在第3、5、7和10年，减肥手术患者的MACE、心力衰竭、脑血管疾病以及冠状动脉手术和操作的发生率显著较低。减肥手术患者在3、5、7、10年的全因死亡率显著较低。敏感性分析证实了这些发现。
对于患有MASLD、肥胖且已患CAD的患者，减肥手术可显著降低心血管事件复发风险，并在减肥手术后的第一年内立即显著提高生存率，且这种效果可长期持续，甚至在减肥手术十年后依然存在。
