• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Your Practice

Does Bariatric Surgery Reduce Cardiovascular Risk for Patients with NASH and Obesity?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE: 

  • Nonalcoholic steatohepatitis (NASH) is the hepatic manifestation of metabolic syndrome 
  • Aminian et al. (JAMA, 2021) investigated the long-term relationship between bariatric surgery and major adverse liver outcomes and major adverse cardiovascular events (MACE) in patients with obesity and NASH 

METHODS: 

  • Retrospective cohort study | SPLENDOR (Surgical Procedures and Long-term Effectiveness in NASH Disease and Obesity Risk) study 
    • Patients undergoing liver biopsy at the Cleveland Clinic health system between 2004 and 2016 
    • Follow up through March 2021 
  • Participants 
    • Adult patients with obesity 
    • Confirmed histological diagnosis of NASH 
    • Presence of liver fibrosis (histological stages 1-3) 
  • Exposures 
    • Bariatric surgery with simultaneous liver biopsy 
      • Roux-en-Y gastric bypass | Sleeve gastrectomy 
    • Nonsurgical control group 
  • Study design 
    • Exposure and control groups were balanced for: Baseline clinical characteristics | Histological disease activity | Fibrosis stage  
    • Regression analysis framework used for primary outcomes calculations  
  • Primary outcomes 
    • Major adverse liver outcomes 
      • Progression to clinical or histological cirrhosis | Development of hepatocellular carcinoma | Liver transplantation | Liver-related mortality 
    • MACE 
      • Composite: Coronary artery events | Cerebrovascular events | Heart failure | Cardiovascular death 

RESULTS: 

  • Bariatric surgery: 650 patients | Nonsurgical controls: 508 patients 
    • 63.9% women 
    • Median (IQR) age: 49.8 (40.9 to 57.9) years 
    • Mean (IQR) BMI: 44.1 (39.4 to 51.4) 
    • Median (IQR) follow-up: 7 (4 to 10) years 
  • Unweighted incidence of outcomes at end of study period 
    • Major adverse liver outcomes 
      • Bariatric surgery: 5 patients 
      • Nonsurgical controls: 40 patients 
    • MACE 
      • Bariatric surgery: 39 patients 
      • Nonsurgical controls: 60 patients 
  • There were fewer major adverse liver events in the bariatric surgery group, with lower risk  
    • Cumulative incidence at 10 years 
      • Bariatric surgery: 2.3% (95% CI, 0 to 4.6) 
      • Nonsurgical controls: 9.6% (95% CI, 6.1 to 12.9) 
    • Adjusted absolute risk difference 12.4% (95% CI, 5.7 to 19.7) 
    • Adjusted hazard ratio 0.12 (95% CI to 0.02 to 0.63); P=0.01 
  • MACE incidence was lower in the bariatric surgery group, and risk was lower 
    • Cumulative incidence at 10 years 
      • Bariatric surgery: 8.5% (95% CI, 5.5 to 11.4) 
      • Nonsurgical controls: 15.7% (95 CI, 11.3 to 19.8) 
    • Adjusted absolute risk difference 13.9% (95% CI, 5.9 to 21.9) 
    • Adjusted hazard ratio 0.30 (95% CI, 0.12 to 0.72); P=0.007 
  • Surgery related adverse events leading to death within first year after surgery: 4 (0.6%) 
    • Gastrointestinal leak: 2 patients 
    • Respiratory failure: 2 patients 

CONCLUSION: 

  • For obese patients with NASH, those that underwent bariatric surgery had a significantly lower risk of major adverse liver events and MACE, compared to nonsurgical controls 
  • The authors state 

NASH and cardiovascular diseases share numerous risk factors because both represent end-organ damage caused by metabolic derangements 

In addition, NASH independently increases the risk of atherosclerosis, cardiomyopathy, and cardiac arrhythmia 

Bariatric surgery leads to a substantial and sustained weight loss, and effectively improves cardiometabolic risk factors6-9 and quality of life 

Learn More – Primary Sources: 

Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis 

image_pdfFavoriteLoadingFavorite
< Previous
All Your Practice Posts
Next >

Related ObG Topics:

Is Bariatric Surgery Associated with a Decreased Risk for Breast Cancer?
Is Bariatric Surgery Associated with Decreased Risks for Severe Birth Defects?
RCT Results: Surgery vs Medical Therapy for Type 2 Diabetes and High BMI

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site