Long‐term Successful Weight Loss Improves Vascular Endothelial Function in Severely Obese Individuals

Abstract

Obesity is associated with increased cardiovascular risk. Although short‐term weight loss improves vascular endothelial function, longer term outcomes have not been widely investigated. We examined brachial artery endothelium‐dependent vasodilation and metabolic parameters in 29 severely obese subjects who lost ≥10% body weight (age 45 ± 13 years; BMI 48 ± 9 kg/m2) at baseline and after 12 months of dietary and/or surgical intervention. We compared these parameters to 14 obese individuals (age 49 ± 11 years; BMI 39 ± 7 kg/m2) who failed to lose weight. For the entire group, mean brachial artery flow‐mediated dilation (FMD) was impaired at 6.7 ± 4.1%. Following sustained weight loss, FMD increased significantly from 6.8 ± 4.2 to 10.0 ± 4.7%, but remained blunted in patients without weight decline from 6.5 ± 4.0 to 5.7 ± 4.1%, P = 0.013 by ANOVA. Endothelium‐independent, nitroglycerin‐mediated dilation (NMD) was unaltered. BMI fell by 13 ± 7 kg/m2 following successful weight intervention and was associated with reduced total and low‐density lipoprotein cholesterol, glucose, hemoglobin A1c, and high‐sensitivity C‐reactive protein (CRP). Vascular improvement correlated most strongly with glucose levels (r = −0.51, P = 0.002) and was independent of weight change. In this cohort of severely obese subjects, sustained weight loss at 1 year improved vascular function and metabolic parameters. The findings suggest that reversal of endothelial dysfunction and restoration of arterial homeostasis could potentially reduce cardiovascular risk. The results also demonstrate that metabolic changes in association with weight loss are stronger determinants of vascular phenotype than degree of weight reduction.

Endothelial Dysfunction in Diabetes: Pathogenesis, Significance, and Treatment

“…In type 2 diabetic patients, a reduction in insulin resistance and fat mass following prolonged aerobic exercise resulted in improvements in lipoprotein metabolism [84]. Dietary restriction, weight loss, and increased physical activity have been shown to improve conduit and resistance artery ED in overweight and obese non-diabetic subjects with and without CAD [85][86][87][88]. In obese, but otherwise healthy subjects, brachial artery FMD improved with a 6-week lowfat diet but was blunted with a low-carbohydrate diet despite similar degrees of weight loss, suggesting that greater vascular benefit is conferred by a low-fat diet [85].…”

Prior Preterm Birth and Maternal Subclinical Cardiovascular Disease 4 to 12 Years After Pregnancy

“…Indeed, weight reduction, salt reduction, increased physical activity, smoking cessation, and stress reduction all have been demonstrated to lower blood pressure and atherogenic lipids, as well as to reverse IMT impairments. [40][41][42] Future studies that apply these interventions to women in the decade following a preterm birth are warranted.…”

Gender effect on vascular responsiveness after bariatric surgery

“…It has been demonstrated that short term weight loss (not by surgery) improves endothelial function within weeks via mechanisms that were related more to metabolic changes than the degree of weight loss [21][22][23][24]. Following non-surgical sustained weight loss, FMD increased significantly but remained blunted in patients without weight decline, and the vascular improvement was correlated most strongly with glucose levels and was independent of weight change [25]. Bariatric surgery resulted in a decrease in BMI with improvement in glucose and lipid metabolism, the carotid intima thickness was diminished significantly and the flow mediated diameter improved from severe dysfunction to normal values.…”