Bariatric surgery is associated with reducing risk for major adverse cardiovascular events and all-cause mortality in individuals with nonalcoholic fatty liver disease (NALFD) and obesity, according to study findings published in JAMA Network Open.

The large population-based study included 152,394 adults, 4,693 of whom underwent bariatric surgery, and 147,701 who were in the nonsurgical group. Patients in the surgical group were propensity-matched 1:1 with patients in the nonsurgical group by age, demographics, comorbidities, and medication. The mean body mass index (BMI) was 43.4 in the surgical group and 42.2 in the nonsurgical group.

Of those who underwent an operation,81.5% were women, 72.7% were non-Hispanic white, 15.4% were non-Hispanic Black, and 8.9% were Hispanic. In the same arm, 34.6% had type 2 diabetes, 58.2% had hypertension, 40.1% had hyperlipidemia, and 51.3% had obstructive sleep apnea. Patients who underwent a bariatric surgery procedure had either the Roux-en-Y gastric bypass or a sleeve gastrectomy.

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Primary outcomes included cardiovascular side effects (ie, unstable angina, myocardial infarction, or revascularization, including percutaneous coronary intervention or coronary artery bypass graft), composite cerebrovascular disease (ie, ischemic or hemorrhagic stroke, cerebral infarction, transient ischemic attack, carotid intervention, or surgery), and artery procedures or surgeries (ie, coronary stenting, percutaneous coronary intervention, or coronary artery bypass).

Mortality was significantly lower in the bariatric surgery group than in the nonsurgical group (HR, 0.56; 95% CI, 0.42-0.74). All-cause mortality was also significantly lower in the bariatric surgery group vs the nonsurgical group when researchers followed up in years 1, 3, 5, and 7.

A total of 271 patients experienced significant complications within the first 30 days after the operation. Of this group, complications included postprocedural hemorrhage (1.1%), gastrointestinal leak (1.3%), postoperative sepsis (1.2%), venous thromboembolism (0.4%), small bowel obstruction (0.8%), acute postprocedural respiratory failure (0.2%), and acute kidney injury (1.1%).

Study limitations include the possibility of residual confounding and a lack of imaging modalities to confirm a diagnosis of NAFLD.

“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,” the study authors noted. “Although our study provides novel information, randomized clinical trials and additional observational studies are needed to corroborate our findings.”

Disclosure: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.


Krishnan A, Hadi Y, Alqahtani SA, et al. Cardiovascular outcomes and mortality after bariatric surgery in patients with nonalcoholic fatty liver disease and obesityJAMA Netw Open. Published online April 7, 2023. doi:10.1001/jamanetworkopen.2023.7188.

This article originally appeared on Gastroenterology Advisor