Role of baseline MASLD parameters and Framingham risk score in cardiovascular risk assessment of bariatric surgery candidates

Abstract

Metabolically–dysfunction–associated steatotic liver disease (MASLD) is highly prevalent among overweight and obese individuals. MASLD potential contribution to cardiovascular risk assessment has been increasingly recognized.

We aimed to evaluate the association between baseline hepatic steatosis and fibrosis parameters and the Framingham Risk Score (FRS) prior to bariatric surgery, as well as their relationship with cardiovascular events post-surgery.

Two hundred and thirty-nine individuals were included: median age of 41 years

(range 19–65) and 87.4% were women.

The mean Fatty Liver Index (FLI) was 80.3±35.9 and 83% of the 239 individuals met the diagnostic criteria for MASLD (FLI>60). The mean Fibrosis-4 (FIB-4) Index for Liver Fibrosis was 0.998 ± 1.7 (n=231), with advanced fibrosis identified in 6% of patients (FIB-4 >2.67).

Mean FRS was 12.7 ± 18.8 (n= 196), indicating high cardiovascular risk in 14.2% of cases.

A moderate positive correlation was observed between FIB-4 and the FRS (rho = 0.48; p < 0.001), revealing an association between liver fibrosis and cardiovascular risk.

Over a median follow-up period of 11 years, 24 (10%) cardiovascular events occurred and 7 (2.9%) individuals died, among the 239 individuals. Of the seven recorded deaths, 4 were caused by cardiovascular events.

No significant associations were observed between baseline FIB-4 and the occurrence of cardiovascular events or death FRS was associated with cardiovascular events (p=0.0023) and mortality (p < 0.001) during follow-up.

Conclusions

In this cohort of overweight and obese individuals undergoing bariatric surgery, baseline FRS but not FIB-4 predicted cardiovascular events following bariatric surgery. Despite the relatively small sample size, these findings suggest that baseline traditional cardiovascular risk scores, but not FIB-4, may have predictive value for cardiovascular risk assessment in this population, despite the modulation of cardiovascular risk associated with bariatric surgery during follow-up. These observations warrant confirmation in larger, prospective studies.