Krishnan Arunkumar, Schneider Carolin V, Mukherjee Diptasree, Woreta Tinsay A, Alqahtani Saleh A
Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.
Department of Supportive Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA.
Diabetol Metab Syndr. 2025 Jun 5;17(1):194. doi: 10.1186/s13098-025-01767-9.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease globally, with a significant association between MASLD and Type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease (CVD). While bariatric surgery (BS) has showed efficacy in improving MASLD markers and reducing CVD incidence, its impact on macrovascular events and all-cause mortality in patients with obesity, MASLD, and T2DM remains understudied.
This retrospective cohort study utilized the TriNetX. Adult patients (> 18 years) with obesity (BMI ≥ 35 kg/m²), MASLD, and T2DM were included. Propensity score matching (1:1) was performed to compare patients undergoing BS with nonsurgical controls. Primary outcomes was the incidence of macrovascular disease, defined as major adverse cardiovascular events (MACE) and cerebrovascular events. Secondary outcomes was all-cause mortality. Cox proportional hazards models were used to calculate hazard ratios (HRs).
A total of 53,204 patients met inclusion criteria, of which 2,463 underwent BS. After matching (2,449 surgical vs. 2,449 nonsurgical patients), BS was associated with a significantly lower risk of macrovascular events (HF: HR 0.68, 95% CI 0.51-0.90; coronary artery disease: HR 0.31, 95% CI 0.21-0.44; cerebrovascular disease: HR 0.38, 95% CI 0.25-0.57) over a mean follow-up of 5.3 years. All-cause mortality was also significantly reduced in the BS group (HR 0.30, 95% CI 0.15-0.62). Sensitivity analyses confirmed the consistency of these results.
This study suggeststhat bariatric surgery significantly lower risk of macrovascular events and all-cause mortality in patients with obesity, MASLD, and T2DM.
代谢功能障碍相关脂肪性肝病（MASLD）是全球最常见的慢性肝病，MASLD与2型糖尿病（T2DM）、肥胖症和心血管疾病（CVD）之间存在显著关联。虽然减肥手术（BS）已显示出改善MASLD指标和降低CVD发病率的疗效，但其对肥胖、MASLD和T2DM患者大血管事件和全因死亡率的影响仍未得到充分研究。
这项回顾性队列研究使用了TriNetX。纳入成年肥胖患者（BMI≥35kg/m²）、MASLD患者和T2DM患者（年龄>18岁）。进行倾向评分匹配（1:1）以比较接受减肥手术的患者与非手术对照组。主要结局是大血管疾病的发生率，定义为主要不良心血管事件（MACE）和脑血管事件。次要结局是全因死亡率。使用Cox比例风险模型计算风险比（HR）。
共有53204名患者符合纳入标准，其中2463人接受了减肥手术。匹配后（2449名手术患者与2449名非手术患者），在平均5.3年的随访中，减肥手术与大血管事件风险显著降低相关（心力衰竭：HR 0.68，95%CI 0.51-0.90；冠状动脉疾病：HR 0.31，95%CI 0.21-0.44；脑血管疾病：HR 0.38，95%CI 0.25-0.57）。减肥手术组的全因死亡率也显著降低（HR 0.30，95%CI 0.15-0.62）。敏感性分析证实了这些结果的一致性。
这项研究表明，减肥手术可显著降低肥胖、MASLD和T2DM患者的大血管事件风险和全因死亡率。
