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

Abstract

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.

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

“…Borzi et al suggested that a slight but significant increase in cardiovascular events occurs in the first months following surgery, when compared with a non-surgical control group [ 17 ]. However, because cardiovascular events follow vascular disease progression that develop over time, it is also reasonable to assume that reducing obesity-related risk factors will also reflect in a reduction in cardiovascular events over time.…”

“…Differential arterial responses to weight reduction surgery have been reported based on metabolic status, highlighting heterogeneity in physiological responses to weight loss and changes in adiposity, and probable activation of separate pathways in clinical subgroups [ 16 ]. However, FMD responses following bariatric surgery may be unchanged [ 17 ].…”

Effect of Roux-en-Y Bariatric Bypass Surgery on Subclinical Atherosclerosis and Oxidative Stress Markers in Leukocytes of Obese Patients: A One-Year Follow-Up Study

“…To our knowledge, this is the first time that a decrease in leukocyte activation and endothelial dysfunction after bariatric surgery has been demonstrated by means of a dynamic system in which an in vivo blood flow is simulated and interaction with endothelial cells can be visualised. Previous studies investigating classic functional and structural markers of early atherosclerosis, such as flow-mediated dilation and carotid artery intima-media thickness, have provided inconsistent results concerning the effects of bariatric surgery on endothelial function [19,42]. Indeed, the mechanisms involved in the early asymptomatic stages of atherosclerosis can be triggered many years before clinical signs are manifested [7], thus suggesting that a leukocyte-endothelial cell interaction-based approach would be useful for early detention of subclinical atherosclerosis risk.…”

Effect of Bariatric Surgery on Intima Media Thickness: A Systematic Review and Meta-Analysis

“…In cohort studies, although most of the selected studies [ 16 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] showed representativeness of the cases, the majority of them were distinguished by a lack of nonexposed group definition information. Since most of the studies did not include a control group, they were not assessed for comparability.…”

“… ( A ) Forest plot displaying standardized mean difference and 95% confidence intervals showing the consequence of bariatric surgery on IMT [ 16 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]; ( B ) Leave-one-out sensitivity analyses indicating the effect of bariatric surgery on IMT [ 16 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , …”