{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T01:15:13Z","timestamp":1788570913067,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Bariatric surgery (BS) is a potential treatment option for patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity. These patients are also at substantial risk of developing cardiovascular events and associated mortality. We aimed to assess whether BS could reduce major adverse cardiovascular events (MACE) and mortality and improve long-term survival.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Using the TriNetX data, adult patients (&amp;gt;18 years) with a diagnosis of MASLD, obesity (i.e. body mass index \u226535\u00a0kg\/m2), and pre-existing coronary artery disease (CAD) between 1 January 2005 and 31 December 2022 were included. Patients with a BS were compared with those with no history of BS. Primary outcomes were the incidence of MACE, heart failure, cerebrovascular events, and coronary artery procedures or surgeries at years 1, 3, 5, 7, and 10. The secondary outcome was all-cause mortality at years 1, 3, 5, 7, and 10. We performed 1:1 propensity score matching (PSM), sensitivity analysis, and survival analysis. After PSM, both groups had a total of 1038 patients. At year 1, BS patients had a significantly lower incidence of MACE [hazard ratio (HR)\u00a0=\u00a00.56; 95% confidence interval (CI), 0.39\u20130.80], cerebrovascular disease (HR\u00a0=\u00a00.62; 95% CI, 0.46\u20130.82), and coronary artery procedures and surgeries (HR\u00a0=\u00a00.65; 95% CI, 0.42\u20130.98). Similarly, at years 3, 5, 7, and 10, BS patients had a significantly lower incidence of MACE, heart failure, cerebrovascular disease, and coronary artery procedures and surgeries. BS patients had significantly lower 3-, 5-, 7-, and 10-year all-cause mortality. Sensitivity analysis confirmed these findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>BS in patients with MASLD, obesity, and pre-existing CAD can considerably reduce the risk of recurring cardiovascular events and markedly improve survival immediately within the first year of BS and can persist long-term, even a decade after BS.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf001","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T20:22:04Z","timestamp":1737404524000},"page":"783-791","source":"Crossref","is-referenced-by-count":4,"title":["Bariatric surgery and cardiovascular outcomes in patients with obesity, metabolic dysfunction-associated steatotic liver disease, and coronary artery disease: a population-based matched cohort study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9452-7377","authenticated-orcid":false,"given":"Arunkumar","family":"Krishnan","sequence":"first","affiliation":[{"name":"Department of Medicine, Wake Forest University School of Medicine , 475 Vine St, Winston-Salem, NC 27101 ,","place":["USA"]},{"name":"Department of Supportive Oncology, Atrium Health Levine Cancer , 1021 Morehead Medical Dr Building 2, Charlotte, NC 28204 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar T","family":"Sims","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation , Cleveland, OH 44106 ,","place":["USA"]},{"name":"Department of Quantitative Health Sciences, Cleveland Clinic Foundation , Cleveland, OH 44106 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Teran","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology and Hepatology, West Virginia University School of Medicine , Morgantown, WV 26506 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinsay A","family":"Woreta","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine , Baltimore, MD 21287 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R","family":"Hutson","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology and Hepatology, West Virginia University School of Medicine , Morgantown, WV 26506 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh A","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center , Riyadh 12713 ,","place":["Saudi Arabia"]},{"name":"Division of Gastroenterology and Hepatology, Weill Cornell Medicine , New York, NY 10065 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"2025091815440969700_bib1","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1007\/s00392-020-01709-7","article-title":"MASLD and cardiovascular diseases: a clinical review","volume":"110","author":"Kasper","year":"2021","journal-title":"Clin Res Cardiol"},{"key":"2025091815440969700_bib2","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"2025091815440969700_bib3","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1016\/j.jhep.2015.11.004","article-title":"EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease","volume":"64","author":"European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO)","year":"2016","journal-title":"J Hepatol"},{"key":"2025091815440969700_bib4","doi-asserted-by":"publisher","first-page":"1691","DOI":"10.1136\/gutjnl-2020-320622","article-title":"MASLD and increased risk of cardiovascular disease: clinical associations, pathophysiological mechanisms and pharmacological implications","volume":"69","author":"Targher","year":"2020","journal-title":"Gut"},{"key":"2025091815440969700_bib5","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1001\/jama.2020.12567","article-title":"Benefits and risks of bariatric surgery in adults: a review","volume":"324","author":"Arterburn","year":"2020","journal-title":"JAMA"},{"key":"2025091815440969700_bib6","doi-asserted-by":"publisher","first-page":"2683","DOI":"10.1056\/NEJMoa035622","article-title":"Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery","volume":"351","author":"Sj\u00f6str\u00f6m","year":"2004","journal-title":"N Engl J Med"},{"key":"2025091815440969700_bib7","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1056\/NEJMoa066603","article-title":"Long-term mortality after gastric bypass surgery","volume-title":"N Engl J Med","author":"Adams","year":"2007"},{"key":"2025091815440969700_bib8","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1016\/j.jhep.2011.03.016","article-title":"The role of thiazolidinediones in non-alcoholic steatohepatitis\u2014a systematic review and meta analysis","volume-title":"J Hepatol","author":"Mahady","year":"2011"},{"key":"2025091815440969700_bib9","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1016\/j.nut.2014.11.018","article-title":"Vitamin E has a beneficial effect on nonalcoholic fatty liver disease: a meta-analysis of randomized controlled trials","volume":"31","author":"Sato","year":"2015","journal-title":"Nutrition"},{"key":"2025091815440969700_bib10","doi-asserted-by":"publisher","first-page":"279","DOI":"10.4300\/jgme-d-12-00156.1","article-title":"Using effect size-or why the P value is not enough","volume":"4","author":"Sullivan","year":"2012","journal-title":"J Grad Med Educ"},{"key":"2025091815440969700_bib11","doi-asserted-by":"publisher","first-page":"e237188","DOI":"10.1001\/jamanetworkopen.2023.7188","article-title":"Cardiovascular outcomes and mortality after bariatric surgery in patients with nonalcoholic fatty liver disease and obesity","volume":"6","author":"Krishnan","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2025091815440969700_bib12","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.amjcard.2019.09.041","article-title":"Comparison of short and long term cardiovascular outcomes after bariatric surgery in patients with vs without coronary artery disease","volume":"125","author":"Pirlet","year":"2020","journal-title":"Am J Cardiol"},{"key":"2025091815440969700_bib13","doi-asserted-by":"publisher","first-page":"138","DOI":"10.4254\/wjh.v11.i2.138","article-title":"Bariatric surgery in patients with non-alcoholic fatty liver disease\u2014from pathophysiology to clinical effects","volume":"11","author":"Laursen","year":"2019","journal-title":"World J Hepatol"},{"key":"2025091815440969700_bib14","doi-asserted-by":"publisher","first-page":"5293","DOI":"10.3390\/jcm11185293","article-title":"The impact of bariatric-surgery-induced weight loss on patients undergoing liver transplant: a focus on metabolism, pathophysiological changes, and outcome in obese patients suffering MASLD-related cirrhosis","volume-title":"J Clin Med","author":"Sarno","year":"2022"},{"key":"2025091815440969700_bib15","doi-asserted-by":"publisher","first-page":"2297","DOI":"10.1001\/jama.2014.5988","article-title":"Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications","volume":"311","author":"Sj\u00f6str\u00f6m","year":"2014","journal-title":"JAMA"},{"key":"2025091815440969700_bib16","doi-asserted-by":"publisher","first-page":"300","DOI":"10.7326\/m17-2383","article-title":"Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care: a matched cohort study","volume":"169","author":"O'Brien","year":"2018","journal-title":"Ann Intern Med"},{"key":"2025091815440969700_bib17","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.1001\/jama.2018.14619","article-title":"Association between bariatric surgery and macrovascular disease outcomes in patients with type 2 diabetes and severe obesity","volume":"320","author":"Fisher","year":"2018","journal-title":"JAMA"},{"key":"2025091815440969700_bib18","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1056\/NEJMoa1700459","article-title":"Weight and metabolic outcomes 12 years after gastric bypass","volume":"377","author":"Adams","year":"2017","journal-title":"N Engl J Med"},{"key":"2025091815440969700_bib19","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1001\/jamasurg.2016.2317","article-title":"Bariatric surgery and long-term durability of weight loss","volume-title":"JAMA Surgery","author":"Maciejewski","year":"2016"},{"key":"2025091815440969700_bib20","doi-asserted-by":"publisher","first-page":"e8632","DOI":"10.1097\/md.0000000000008632","article-title":"Effectiveness of bariatric surgical procedures: a systematic review and network meta-analysis of randomized controlled trials","volume":"96","author":"Kang","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"2025091815440969700_bib21","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1007\/s11695-017-2871-7","article-title":"Influence of patient choice on outcome of bariatric surgery","volume":"28","author":"Vasas","year":"2018","journal-title":"Obes Surg"},{"key":"2025091815440969700_bib22","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.1007\/s11695-014-1270-6","article-title":"Patient preferences and bariatric surgery procedure selection; the need for shared decision-making","volume":"24","author":"Weinstein","year":"2014","journal-title":"Obes Surg"},{"key":"2025091815440969700_bib23","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1002\/hep.31726","article-title":"Administrative coding in electronic health care record-based research of MASLD: an expert panel consensus statement","volume":"74","author":"Hagstr\u00f6m","year":"2021","journal-title":"Hepatology"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcaf001\/61522127\/qcaf001.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/6\/783\/61522127\/qcaf001.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/6\/783\/61522127\/qcaf001.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T19:44:15Z","timestamp":1758224655000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/11\/6\/783\/7964872"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,20]]},"references-count":23,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,1,20]]},"published-print":{"date-parts":[[2025,9,12]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcaf001","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,1,20]]}}}