Bariatric Surgery Can Have Dramatic Effect on Cardiovascular Risk in NAFLD with Obesity


A retrospective, propensity score-matched analysis details significant risk reductions achieved with bariatric surgery in patients with nonalcoholic fatty liver disease and obesity.

Shailendra Singh, MD | Courtesy: Facebook

Shailendra Singh, MD
Courtesy: Facebook

Undergoing bariatric surgery could significantly reduce the risk of a slew of major cardiovascular events, including new-onset heart failure, cerebrovascular events, and need for coronary interventions, in patients with nonalcoholic fatty liver disease (NAFLD) and obesity.

According to study results, patients with NAFLD and obesity who underwent bariatric surgery had a 44% lower risk of death, a 40% lower risk of heart failure, and a 53% lower risk of need for coronary interventions, as well as reductions in other adverse events, when compared to their counterparts without bariatric surgery.1

“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,” wrote investigators.1

A condition with no treatment options approved by the US Food and Drug Administration, NAFLD represents a significant area of unmet need in cardiometabolic health.2 With its demonstrated efficacy and evolving safety profile, bariatric surgery has increased in popularity in recent decades.3

Citing an interest in the potential benefits of bariatric surgery on incidence of major adverse cardiovascular events (MACE) in patients with NAFLD and obesity, a team led by Shailendra Singh, MD, of the West Virginia University School of Medicine, designed the current study as a retrospective analysis of data within the TriNetX platform. With a period of interest defined as 2005-2021, the TriNetX platform provided investigators with information related to 152,394 individuals aged 18 years or older with a diagnosis of NAFLD and a BMI of 35 kg/m2 or greater.1

For the purpose of analysis, investigators used 1:1 propensity matching based on age, demographics, comorbidities, and medication to identify matching cohorts of 4687 patients who did and did not undergo bariatric surgery. The mean follow-up time was 5.1 (SD, 1.7) years for the bariatric surgery group and 4.3 (SD, 1.1) years for the non-bariatric surgery group.1

The primary outcome of interest for the analysis was the incidence of new-onset MACE, with events categorized as heart failure, composite cardiovascular events, composite cerebrovascular events, and composite coronary artery interventions.1

Upon analysis, a significant reduction in relative risk was observed for new-onset heart failure (Hazard ratio [HR], 0.60 [95% confidence interval [CI], 0.51-0.70), cardiovascular events (HR, 0.53 [95% CI, 0.44-0.65]), cerebrovascular events (HR, 0.59 [95% CI, 0.51-0.69]), coronary artery interventions (HR, 0.47 [95% CI, 0.35-0.63]), and all-cause mortality (HR, 0.56 [95% CI, 0.42-0.74])for the bariatric surgery group. Investigators pointed out further analysis indicated these outcomes were consistent at 1, 3, 5, and 7 years of follow-up.1

“The findings of this cohort study suggest that [bariatric surgery] was associated with a lower incidence of major adverse cardiovascular events and all-cause mortality in patients with NAFLD and obesity,” investigators concluded.1 “Although our study provides novel information, randomized clinical trials and additional observational studies are needed to corroborate our findings.”


  1. Singh S, Krishnan A, Hadi Y. Cardiovascular Outcomes and Mortality After Bariatric Surgery in Patients With Nonalcoholic Fatty Liver Disease and Obesity. JAMA Network Open. April 2023. doi:doi: 10.1001/jamanetworkopen.2023.7188
  2. Walter K. Often neglected, hope is on the way for fatty liver disease patients. HCP Live. Published March 29, 2023. Accessed April 6, 2023.
  3. Campbell P. Comprehensive study, boasting 40 years of follow-up, underlines long-term benefits of bariatric surgery. HCP Live. Published February 10, 2023. Accessed April 6, 2023.

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