Long-term effects of bariatric surgery on peripheral endothelial function and coronary microvascular function

Tarzia, Pierpaolo; Lanza, Gaetano Antonio; Sestito, Alfonso; Villano, Angelo; Russo, Giulio; Figliozzi, Stefano; Lamendola, Priscilla; Vita, Antonio De; Crea, Filippo

doi:10.1016/j.orcp.2016.12.005

Cited by 19 publications

(12 citation statements)

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“…Bariatric surgery has been shown to improve metabolism, reduce morbidity and mortality, and favorably remodel the vasculature. 8,[13][14][15][16][26][27][28][29][30][31][32] Clinical studies have observed improvement in FMD and carotid intima thickening (CIMT) after bariatric operations, 13,16,26,31,[33][34][35] and amelioration of metabolic syndrome, type 2 diabetes, and insulin resistance have been associated with enhanced…”

Section: Discussionmentioning

confidence: 99%

“…Bariatric surgery has been shown to improve metabolism, reduce morbidity and mortality, and favorably remodel the vasculature. 8 , 13 , 14 , 15 , 16 , 26 , 27 , 28 , 29 , 30 , 31 , 32 Clinical studies have observed improvement in FMD and carotid intima thickening (CIMT) after bariatric operations, 13 , 16 , 26 , 31 , 33 , 34 , 35 and amelioration of metabolic syndrome, type 2 diabetes, and insulin resistance have been associated with enhanced microvascular function. 14 , 30 , 36 , 37 , 38 , 39 Thus, our findings extend these previous reports that involved smaller cohorts and shorter follow-up periods.…”

Section: Discussionmentioning

confidence: 99%

“… 6 , 7 , 8 , 9 , 10 , 11 Data from our group and others have demonstrated that reduction in cardiovascular risk may occur as a function of reversing vascular endothelial dysfunction and insulin resistance. 12 , 13 , 14 , 15 , 16 The objective of our present longitudinal study was to identify variables associated with vascular improvement after bariatric surgery and examine how sex, race, and metabolic status are associated with microvascular and macrovascular outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Association of Bariatric Surgery With Vascular Outcomes

et al. 2021

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IMPORTANCE Bariatric surgical weight loss is associated with reduced cardiovascular mortality; however, the mechanisms underlying this association are incompletely understood.OBJECTIVES To identify variables associated with vascular remodeling after bariatric surgery and to examine how sex, race, and metabolic status are associated with microvascular and macrovascular outcomes. DESIGN, SETTING, AND PARTICIPANTSThis population-based longitudinal cohort included 307 individuals who underwent bariatric surgery. Participants were enrolled in the bariatric weight loss program at Boston Medical Center, a large, multi-ethnic urban hospital, with presurgical and postsurgical assessments. Data were collected from December 11, 2001 to August 27, 2019. Data were analyzed in September 2019. EXPOSURE Bariatric surgery. MAIN OUTCOMES AND MEASURES Flow-mediated dilation (FMD) and reactive hyperemia (RH) (as measures of macrovascular and microvascular function, respectively) and clinical variables were measured preoperatively at baseline and at least once postoperatively within 12 months of the bariatric intervention. RESULTS A total of 307 participants with obesity (mean [SD] age, 42 [12] years; 246 [80%] women; 199 [65%] White; mean [SD] body mass index, 46 [8]) were enrolled in this study. Bariatric surgery was associated with significant weight loss and improved macrovascular and microvascular function across subgroups of sex, race, and traditional metabolic syndrome (mean [SD] pre-vs postsurgery weight: 126 [25] kg vs 104 [25] kg; P < .001; mean [SD] pre-vs postsurgery FMD: 9.1% [5.3] vs 10.2% [5.1]; P < .001; mean [SD] pre-vs postsurgery RH: 764% [400] vs 923% [412]; P < .001). Factors associated with change in vascular phenotype correlated most strongly with adiposity markers and several metabolic variables depending on vascular territory (eg, association of weight change with change in RH: estimate, −3.2; 95% CI, −4.7 to −1.8; association of hemoglobin A 1c with change in FMD:estimate, −0.5; 95% CI, −0.95 to −0.05). While changes in macrovascular function among individuals with metabolically healthy obesity were not observed, the addition of biomarker assessment using high-sensitivity C-reactive protein plasma levels greater than 2 mg/dL identified participants with seemingly metabolically healthy obesity who had low-grade inflammation and achieved microvascular benefit from weight loss surgery. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that bariatric intervention is associated with weight loss and favorable remodeling of the vasculature among a wide range of individuals with cardiovascular risk. Moreover, differences in arterial responses to weight loss surgery (continued) Key Points Question Is bariatric surgical weight loss intervention for obesity associated with microvascular and macrovascular outcomes, and are they differentially associated with sex, race, and metabolic status? Findings In 307 individuals with obesity who were followed up after bariatric surgery, the procedure was associated with ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Bariatric Surgery With Vascular Outcomes

et al. 2021

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“…Bigornia et al demonstrated that FMD increased following weight loss but, unfortunately, they included both patients undergoing BS and MNT in the same cohort so that it was not possible to clearly demonstrate the efficacy of surgery. 28 Interestingly, Tarzia et al recently demonstrated, in a cohort of obese individuals undergoing BS, that the improvement in FMD first observed at 3 months was maintained even after follow-up at 4 years; 29 however, of the original sample of 50 patients, only 19 agreed to continue the long-term followup; thus, data regarding the remaining part of the cohort are missing. Furthermore, consistent with these results, three studies described a significant increase of FMD after the intervention.…”

Section: Discussionmentioning

confidence: 99%

<p>Endothelial Function in Obese Patients Treated with Bariatric Surgery</p>

Borzì¹,

Buscemi²,

Corleo³

et al. 2020

DMSO

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Bariatric surgery (BS) is becoming an increasingly frequent treatment option especially in people with morbid obesity, demonstrating that it is able to reduce total mortality and cardiovascular (CV) risk. Despite endothelial dysfunction is an essential requisite contributing to atherosclerosis and predicting CV events, only some studies have investigated the effects of BS on endothelial function with controversial results. In this study, the effects of weight loss on endothelial function were investigated in obese patients after BS and compared with patients after medical nutrition treatment (MNT). Patients and Methods: Seventeen obese patients who underwent BS procedures (9 adjustable gastric bands, 3 gastric bypasses and 5 biliopancreatic diversions) were included in the study and compared with 18 obese individuals who underwent MNT. Endothelial function was investigated by flow-mediated dilation (FMD) of the brachial artery. Also, carotid intima-media thickness (c-IMT) was measured as a marker of subclinical atherosclerosis. Results: At the end of follow-up, the mean weight loss was 18.8% in the BS group and 7.0% in the MNT group. After treatment, FMD significantly decreased in the BS group (mean ± SD before: 9.0 ± 4.7; after: 6.1 ± 2.9%; P= 0.04); however, no significant change was observed in the MNT group (before: 9.4 ± 5.8; after: 8.3 ± 5.3; P= 0.41). The modification of endothelial function was negatively correlated with c-IMT change in the BS group (r= −0.63; P <0.007). Conclusion: A significant endothelial dysfunction occurred following BS but not after MNT. Furthermore, the decline of endothelial function observed in the BS group might have contributed to atherosclerosis.

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“…Sustained weight loss achieved with Roux-en-Y gastric bypass surgery has been shown to be associated with less coronary calcification independent of changes in LDLcholesterol [9]. Bariatric surgery has also been reported to improve peripheral endothelial function and coronary microvascular function at a 4-year follow-up of the morbidly obese subjects [10]. Moreover, several reports indicate that bariatric surgery reduces the incidence of myocardial infarction as well as the need for coronary revascularization in morbidly obese patients [11].…”

Section: Introductionmentioning

confidence: 99%

The impact of weight loss after laparoscopic sleeve gastrectomy on early markers of atherosclerotic vascular disease: a prospective study

Kaya

Elkan

2020

Kardiol Pol

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What's new?Given the effect of obesity in the development of coronary artery disease, several approaches, including bariatric surgery, have been developed to facilitate weight loss in these patients.Despite the improvement achieved in weight loss with bariatric surgery, the impact of this procedure on markers of the coronary artery disease burden has not been studied yet.The present study clearly demonstrates that in morbidly obese subjects laparoscopic sleeve gastrectomy not only reduces total body weight but also leads to a significant improvement in surrogate markers of atherosclerotic burden, including aortic propagation velocity, carotid intima-media thickness, ankle-brachial index, and epicardial fat thickness at postoperative 6 months. In addition, a significant reduction occurred in systolic and diastolic blood pressures, triglyceride, and LDL-cholesterol levels from baseline to the postoperative 6 months. ABSTRACT Background: Considering the emerging role of the aortic propagation velocity (APV) in the determination of the coronary artery disease (CAD) burden, we hypothesized that laparoscopic sleeve gastrectomy (LSG) could provide improvement in APV in morbidly obese subjects Aims: This study purposed to investigate the impact of LSG on surrogate markers of the atherosclerotic vascular disease such as APV, carotid intima-media thickness (CIMT), epicardial fat thickness (EFT) and ankle-brachial index (ABI) in subjects with morbid obesity. Methods: Seventy-one subjects who were scheduled for LSG for standard indications stated by the international guidelines were prospectively enrolled in the study. All subjects underwent transthoracic echocardiography, carotid ultrasonography. Delta (Δ) values were obtained by subtracting sixth-month values from the baseline values.Results: LSG led to a significant reduction in body weight and at postoperative 6 months.There was a significant reduction in systolic and diastolic blood pressure and in triglyceride and LDL cholesterol levels. Moreover, significant reductions in EFT, and CIMT and significant increases in ABI and APV were noted at postoperative six months compared to the baseline measurements. The change in APV was significantly correlated with systolic blood pressure, diastolic blood, EFT, ABI and CIMT.Conclusion: LSG leads to significant improvements in BMI, and CIMT, EFT, ABI, and APV, which are the surrogate markers of atherosclerotic vascular disease, in morbidly obese subjects at postoperative 6 months. The improvement in APV is correlated with the improvement in BMI, CIMT, EFT, and ABI.

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Long-term effects of bariatric surgery on peripheral endothelial function and coronary microvascular function

Cited by 19 publications

References 15 publications

Association of Bariatric Surgery With Vascular Outcomes

Association of Bariatric Surgery With Vascular Outcomes

<p>Endothelial Function in Obese Patients Treated with Bariatric Surgery</p>

The impact of weight loss after laparoscopic sleeve gastrectomy on early markers of atherosclerotic vascular disease: a prospective study

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