Macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction–associated steatotic liver disease, and Type 2 diabetes
Abstract Background 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 sho...
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BMC
2025-06-01
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| Series: | Diabetology & Metabolic Syndrome |
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| Online Access: | https://doi.org/10.1186/s13098-025-01767-9 |
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| author | Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani |
| author_facet | Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani |
| author_sort | Arunkumar Krishnan |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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). Results 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. Conclusions This study suggeststhat bariatric surgery significantly lower risk of macrovascular events and all-cause mortality in patients with obesity, MASLD, and T2DM. |
| format | Article |
| id | doaj-art-96d5f4cd860248b880aaa74bc2f68df4 |
| institution | OA Journals |
| issn | 1758-5996 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Diabetology & Metabolic Syndrome |
| spelling | doaj-art-96d5f4cd860248b880aaa74bc2f68df42025-08-20T02:30:43ZengBMCDiabetology & Metabolic Syndrome1758-59962025-06-0117111110.1186/s13098-025-01767-9Macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction–associated steatotic liver disease, and Type 2 diabetesArunkumar Krishnan0Carolin V. Schneider1Diptasree Mukherjee2Tinsay A. Woreta3Saleh A. Alqahtani4Department of Medicine, Wake Forest University School of MedicineDepartment of Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH AachenDepartment of Medicine, Apex Institute of Medical ScienceDivision of Gastroenterology and Hepatology, Johns Hopkins University School of MedicineOrgan Transplant Center of Excellence, King Faisal Specialist Hospital & Research CenterAbstract Background 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. Methods 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). Results 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. Conclusions This study suggeststhat bariatric surgery significantly lower risk of macrovascular events and all-cause mortality in patients with obesity, MASLD, and T2DM.https://doi.org/10.1186/s13098-025-01767-9Metabolic dysfunction-associated steatotic liver diseaseBariatric surgeryType 2 diabetes mellitusCardiovascular diseaseMacrovascular complicationsMajor adverse cardiovascular events |
| spellingShingle | Arunkumar Krishnan Carolin V. Schneider Diptasree Mukherjee Tinsay A. Woreta Saleh A. Alqahtani Macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction–associated steatotic liver disease, and Type 2 diabetes Diabetology & Metabolic Syndrome Metabolic dysfunction-associated steatotic liver disease Bariatric surgery Type 2 diabetes mellitus Cardiovascular disease Macrovascular complications Major adverse cardiovascular events |
| title | Macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction–associated steatotic liver disease, and Type 2 diabetes |
| title_full | Macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction–associated steatotic liver disease, and Type 2 diabetes |
| title_fullStr | Macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction–associated steatotic liver disease, and Type 2 diabetes |
| title_full_unstemmed | Macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction–associated steatotic liver disease, and Type 2 diabetes |
| title_short | Macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction–associated steatotic liver disease, and Type 2 diabetes |
| title_sort | macrovascular outcomes and mortality after bariatric surgery in patients with metabolic dysfunction associated steatotic liver disease and type 2 diabetes |
| topic | Metabolic dysfunction-associated steatotic liver disease Bariatric surgery Type 2 diabetes mellitus Cardiovascular disease Macrovascular complications Major adverse cardiovascular events |
| url | https://doi.org/10.1186/s13098-025-01767-9 |
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