Effect of Bariatric Surgery on Flow-Mediated Vasodilation as a Measure of Endothelial Function: A Systematic Review and Meta-Analysis

Abstract

Objectives. Flow mediated vasodilation (FMD) is a marker of endothelial function and its decline is related to increased cardiovascular risk. This systematic review and meta-analysis evaluated the impact of bariatric surgery on FMD. Materials and methods. A systematic literature search in PubMed, Scopus, Embase, and Web of Science was performed to 1 May 2021. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V2 software. All types of bariatric surgery were considered, with the inclusion that FMD had to have been tested before and after the surgical procedure. Meta-analysis was carried out using a random-effects model and the generic inverse variance approach. The leave-one-out approach was used for sensitivity analysis. To assess metabolic parameter confounders, a weighted random-effects meta-regression was used. Results. A meta-analysis and a systematic review of 23 studies (n = 891 individuals) demonstrated improvement in FMD following bariatric surgery (weighted mean difference (WMD): 5.867, 95% CI: 4.481, 7.252, p < 0.001; I2: 96.70). Iteratively removing each item in the meta-analysis did not result in a significant alteration in the pooled estimate of effect size. There was an improvement in FMD for up to 6 months following bariatric surgery in a meta-analysis from 7 trials that included 356 subjects (WMD: 5.248, 95% CI: 2.361, 8.135, p < 0.001; I2: 98.18). The meta-analysis from 9 trials (n = 414 subjects) showed an improvement in FMD 6 to 12 months after bariatric surgery (WMD: 5.451, 95% CI: 3.316, 7.587, p < 0.001; I2: 94.18). The meta-analysis from 10 trials (n = 414 subjects) demonstrated an improvement in FMD 12 months after bariatric surgery (WMD: 2.401, 95% CI: 0.944, 3.859, p = 0.001; I2: 88.35). Random-effects meta-regression did not show any association between the alteration in FMD and percent body mass index (BMI) change (slope: 0.0258; 95% CI: −0.323, 0.375; p = 0.884), or changes in blood pressure; however, there was an association between the changes in FMD and the duration of follow-up (slope: −0.106; 95% CI: −0.205, −0.008; p = 0.033) with greater changes in FMD after 12 months. Conclusions. Bariatric surgery significantly improved FMD that increased with time, and the resultant improvement in endothelial function was independent of weight loss or a reduction in blood pressure.

Impact of bariatric surgery on circulating PCSK9 levels as marker of cardiovascular disease risk: a meta-analysis

“…This is the first meta-analysis evaluating the impacts of bariatric surgery on PCSK9 as a regulator of plasma cholesterol levels. This finding is consistent is with other reports suggesting a positive impact of bariatric surgery on cardiovascular risk factors (17)(18)(19)(20). The observed drop in circulating PCSK9 levels could be attributed to long-term weight loss caused by bariatric procedure as well as sustained decreases in total food intake (11).…”

Ischemia with Nonobstructive Coronary Artery Disease and Atrial Cardiomyopathy—Two Sides of the Same Story?

“…A recent meta-analysis showed that obese patients who had undergone bariatric surgery had significant improvement in endothelial function ascertained by increasing FMD measurements, independent of the weight loss, suggesting that weight-independent mechanisms such as endocrine and incretin-mediated effects and improved inflammatory status might contribute as well to the amelioration of ED [ 90 ].…”

The Effect of Bariatric Surgery on Circulating Levels of Lipoprotein (a): A Meta-analysis

“…Weight loss has beneficial effects on the main risk factors for ASCVD including elevated total and LDL-cholesterol (LDL-C), triglycerides, and decreased HDL-cholesterol (HDL-C) [6]. Bariatric surgery has beneficial effects on cardiovascular indices [7][8][9]. For instance, it has been shown that gastric bypass surgery improved all lipid profile parameters, although sleeve gastrectomy only improved HDL-C and triglyceride levels [10,11].…”