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Esparham A, Roohi S, Ahmadyar S, Dalili A, Nelson PR, Khorgami Z. Impact of bariatric surgery on carotid intima-media thickness, flow-mediated dilation, and nitrite-mediated dilation: a systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:1188-1199. [PMID: 37429755 DOI: 10.1016/j.soard.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/03/2023] [Accepted: 05/14/2023] [Indexed: 07/12/2023]
Abstract
Obesity is considered one of the independent risk factors for atherosclerosis and is strongly correlated with cardiovascular morbidity and mortality. Previous studies showed carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and nitrite-mediated dilatation (NMD) are reliable non-invasive markers of arterial damage and dysfunction. The aim of this study was to evaluate the effect of bariatric surgery on CIMT, FMD, and NMD markers in patients with obesity. A systematic search was performed in the PubMed, Embase, Scopus, and Web of Science databases until May 2022. All the English-published studies on the effect of bariatric surgery on CIMT, FMD, and NMD were included. A quantitative meta-analysis was performed, as well as subgroup analyses for the type of procedure and duration of follow-up. Meta-analysis of 41 studies with 1639 patients showed CIMT was significantly reduced by .11 mm after bariatric surgery (95% CI, -.14 to -.08; P < .001; mean follow-up = 10.8 mo). The pooled analysis of 23 studies with 1106 patients showed an increase of FMD by 4.57% after bariatric surgery (95% CI, 2.69-6.44; P < .001; mean follow-up = 11.5 mo). The results of a pooled analysis of 12 studies with 346 patients showed a significant increase of NMD by 2.46% after bariatric surgery (95% CI, .99-3.94; P < .001; mean follow-up = 11.4 mo). The random effect meta-regression demonstrated that baseline CIMT and FMD significantly affect the changes in CIMT and FMD. This meta-analysis showed bariatric surgery can improve CIMT, FMD, and NMD markers in patients with obesity. These improvements show the known effect of metabolic surgery in decreasing cardiovascular risk.
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Affiliation(s)
- Ali Esparham
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Roohi
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Ahmadyar
- Student Research Committee, College of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Dalili
- Department of General Surgery, School of Medicine, Surgical Oncology Research Center, Imam, Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma, Tulsa, Oklahoma
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Lopes KG, de Souza MDGC, Bouskela E, Kraemer-Aguiar LG. Microvascular Function, Inflammatory Status, and Oxidative Stress in Post-Bariatric Patients with Weight Regain. Nutrients 2023; 15:2135. [PMID: 37432255 DOI: 10.3390/nu15092135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 07/12/2023] Open
Abstract
Weight loss after bariatric surgery in obesity improves vascular function and metabolic/inflammatory profiles and reduces cardiovascular mortality but there are limited data on the effects of weight regain on vascular health. We compared the metabolic/inflammatory profiles, oxidative status, and vascular function of post-bariatric patients with a high ratio of weight regain (RWR) vs. non-surgical controls. Thirty-two post-bariatric patients [Roux-en-Y gastric bypass; aged = 44 ± 8 years, BMI = 40.1 ± 7.7 kg/m2, and RWR = 58.7 ± 24.3%] and thirty controls that were BMI-, age-, and gender-matched entered the study. We collected clinical data, metabolic/inflammatory/oxidative stress circulating biomarkers, and endothelial/microvascular reactivity through Venous occlusion plethysmography and Laser speckle contrast imaging. The bariatric group exhibited lower neck circumference, fasting glucose, and triglycerides than the non-surgical group, while HDL-cholesterol was higher in the bariatric group (p < 0.001). There was no significant difference between groups for endothelial/microvascular reactivities (p ≥ 0.06). Resistin, leptin, endothelin-1, soluble forms of intercellular cell adhesion molecule-1 and vascular cell adhesion molecule-1, tumor necrosis factor-α, and thiobarbituric acid reactive substances did not differ significantly between groups (p ≥ 0.09) either. The adiponectin level was higher in the bariatric compared to the non-surgical group, while interleukin-6 was lower in the bariatric group (p < 0.001). Despite the fact that endothelial/microvascular functions were not significantly different between groups, post-bariatric patients present partially preserved metabolic/inflammatory benefits even with high RWR.
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Affiliation(s)
- Karynne Grutter Lopes
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Postgraduate Program in Clinical and Experimental Physiopathology (Fisclinex), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Laboratory for Clinical and Experimental Research on Vascular Biology (Biovasc), Rio de Janeiro State University, Rio de Janeiro 20550-013, RJ, Brazil
| | - Maria das Graças Coelho de Souza
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Postgraduate Program in Clinical and Experimental Physiopathology (Fisclinex), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Laboratory for Clinical and Experimental Research on Vascular Biology (Biovasc), Rio de Janeiro State University, Rio de Janeiro 20550-013, RJ, Brazil
| | - Eliete Bouskela
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Postgraduate Program in Clinical and Experimental Physiopathology (Fisclinex), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Laboratory for Clinical and Experimental Research on Vascular Biology (Biovasc), Rio de Janeiro State University, Rio de Janeiro 20550-013, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Postgraduate Program in Clinical and Experimental Physiopathology (Fisclinex), Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
- Laboratory for Clinical and Experimental Research on Vascular Biology (Biovasc), Rio de Janeiro State University, Rio de Janeiro 20550-013, RJ, Brazil
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-013, RJ, Brazil
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Wronka M, Krzemińska J, Młynarska E, Rysz J, Franczyk B. New Insights into the Use of Liraglutide-Impact on Cardiovascular Risk and Microvascular Outcomes. Biomedicines 2023; 11:biomedicines11041159. [PMID: 37189777 DOI: 10.3390/biomedicines11041159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Despite the availability of many glucose-lowering drugs, patients with type 2 diabetes mellitus (T2DM) often do not achieve the desired effect, and cardiovascular complications remain the leading cause of death in this group of patients. Recently, more and more attention has been paid to the properties of drugs, with particular emphasis on the possibility of reducing cardiovascular risk. One of them is liraglutide, which belongs to long-acting analogs of glucagon-like peptides-1 (GLP-1); it imitates incretins and causes an increase in insulin secretion. The current study focused on analyzing the efficacy and safety of liraglutide, as well as its impact on microvascular and cardiovascular outcomes in the treatment of patients with T2DM. Hyperglycemia-induced endothelial dysfunction, which is known to play a key role in maintaining cardiovascular homeostasis, is common in diabetes. Liraglutide reduces endothelial dysfunction by reversing damage to endothelial cells. By reducing the generation of reactive oxygen species (ROS), thereby affecting Bax, Bcl-2 protein levels, and restoring signaling pathways, Liraglutide reduces oxidative stress, inflammation, and prevents endothelial cell apoptosis. Liraglutide has beneficial effects on the cardiovascular system; patients with high cardiovascular risk particularly benefit from treatment, as it reduces their major adverse cardiovascular event (MACE) rate, which takes into account cardiovascular death, stroke, and non-fatal myocardial infarction. Liraglutide reduces the occurrence and progression of nephropathy, which is one of the most common microvascular complications of diabetes.
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Affiliation(s)
- Magdalena Wronka
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Julia Krzemińska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
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Chen Y, Liu Y, Cong L, Liu A, Song X, Liu W, Hua R, Shen Q, Shao Y, Xue Y, Yao Q, Zhang Y. Sleeve gastrectomy improved microvascular phenotypes from obesity cohort, detected with optical coherence tomography angiography. J Diabetes 2023; 15:313-324. [PMID: 36872300 PMCID: PMC10101840 DOI: 10.1111/1753-0407.13374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
AIMS To examine how metabolic status is associated with microvascular phenotype and to identify variables associated with vascular remodeling after bariatric surgery, using noninvasive optical coherence tomography angiography (OCTA). METHODS The study included 136 obese subjects scheduled for bariatric surgery and 52 normal-weight controls. Patients with obesity were divided into metabolically healthy obesity (MHO) and metabolic syndrome (MetS) groups according to the diagnosis criteria of the Chinese Diabetes Society. Retinal microvascular parameters were measured by OCTA, including superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities. Follow-ups were performed at the baseline and 6 months after bariatric surgery. RESULTS Fovea SCP, average DCP, fovea DCP, parafovea DCP, and perifovea DCP vessel densities were significantly lower in the MetS group, compared to controls (19.91% vs. 22.49%, 51.60% vs. 54.20%, 36.64% vs. 39.14%, 56.24% vs. 57.65% and 52.59% vs. 55.58%, respectively, all p < .05). Parafovea SCP, average DCP, parafovea DCP, and perifovea DCP vessel densities significantly improved in patients with obesity 6 months after surgery, compared to baseline (54.21% vs. 52.97%, 54.43% vs. 50.95%, 58.29% vs. 55.54% and 55.76% vs. 51.82%, respectively, all p < .05). Multivariable analyses showed that baseline blood pressure and insulin were independent predictors of vessel density changes 6 months after surgery. CONCLUSIONS Retinal microvascular impairment occurred mainly in MetS rather than MHO patients. Retinal microvascular phenotype improved 6 months after bariatric surgery and baseline blood pressure and insulin status may be key determinants. OCTA may be a reliable method to evaluate the microvascular complications associated with obesity.
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Affiliation(s)
- Yaying Chen
- Department of OphthalmologyHuadong Hospital, Fudan UniversityShanghaiChina
- Department of OphthalmologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Yanyang Liu
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Lin Cong
- Department of OphthalmologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Ailin Liu
- Department of UltrasoundHuashan Hospital, Fudan UniversityShanghaiChina
| | - Xiangyuan Song
- Department of OphthalmologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Wenting Liu
- Department of OphthalmologyHuadong Hospital, Fudan UniversityShanghaiChina
| | - Rong Hua
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Qiwei Shen
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Yikai Shao
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Yiwen Xue
- Department of OphthalmologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Qiyuan Yao
- Center for Obesity and Metabolic SurgeryHuashan Hospital, Fudan UniversityShanghaiChina
| | - Yuyan Zhang
- Department of OphthalmologyHuadong Hospital, Fudan UniversityShanghaiChina
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Xia Y, Liang C, Kang J, You K, Xiong Y. Obstructive Sleep Apnea and Obesity Are Associated with Hypertension in a Particular Pattern: A Retrospective Study. Healthcare (Basel) 2023; 11:healthcare11030402. [PMID: 36766978 PMCID: PMC9913941 DOI: 10.3390/healthcare11030402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) and obesity can increase the risk of hypertension, but the combined effects of these two conditions on hypertension are not yet known. We collected the basic characteristics, sleep parameters, and glucose levels of subjects with a polysomnography test and divided them into four groups, according to whether they had severe OSA and obesity or not. The main effects of severe OSA and obesity and the interactions of the two on systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels were detected using analysis of covariance. The association between obesity and severe OSA and abnormal blood pressure and their combined effects were detected with logistic regression. In total, 686 subjects were included. After adjusting for multiple confounding factors, the strong main effects of obesity and severe OSA were detected in the SBP and DBP levels, with no combined effects from the two conditions on SBP or DBP. Obesity was independently associated with the presence of hyper-systolic blood pressure (hyper-SBP) and hypertension, and severe OSA was independently associated with the presence of hyper diastolic blood pressure (hyper-DBP) and hypertension. No effects of the interaction between severe OSA and obesity on the presence of abnormal blood pressure were observed. Both severe OSA and obesity were associated with hypertension, while obesity was closely associated with hyper-SBP, and severe OSA was associated with hyper-DBP. No effects of the interaction between these two on hypertension were observed.
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Affiliation(s)
- Yunyan Xia
- Department of Otorhinolaryngology–Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Caihong Liang
- Department of Otorhinolaryngology–Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Junxin Kang
- Department of Otorhinolaryngology–Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Kai You
- Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
- Correspondence: (K.Y.); (Y.X.)
| | - Yuanping Xiong
- Department of Otorhinolaryngology–Head and Neck Surgery, First Affiliated Hospital of Nanchang University, Nanchang 330006, China
- Correspondence: (K.Y.); (Y.X.)
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Jamialahmadi T, Alidadi M, Atkin SL, Kroh M, Almahmeed W, Moallem SA, Al-Rasadi K, Rodriguez JH, Santos RD, Ruscica M, Sahebkar A. Effect of Bariatric Surgery on Flow-Mediated Vasodilation as a Measure of Endothelial Function: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:4054. [PMID: 35887817 PMCID: PMC9323618 DOI: 10.3390/jcm11144054] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Tannaz Jamialahmadi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;
| | - Mona Alidadi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;
| | - Stephen L. Atkin
- School of Postgraduate Studies and Research, RCSI Medical University of Bahrain, Busaiteen 15503, Bahrain;
| | - Matthew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA;
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi P.O. Box 124140, United Arab Emirates;
| | - Seyed Adel Moallem
- Department of Pharmacology and Toxicology, College of Pharmacy, Al-Zahraa University for Women, Karbala, Iraq;
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khalid Al-Rasadi
- Medical Research Centre, Sultan Qaboos University, Muscat P.O. Box 373, Oman;
| | - John H. Rodriguez
- Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi P.O. Box 112412, United Arab Emirates;
| | - Raul D. Santos
- Lipid Clinic Heart Institute (Incor), University of São Paulo, Medical School Hospital, São Paulo 01000, Brazil;
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20100 Milan, Italy;
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
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Impact of Laparoscopic Sleeve Gastrectomy on Thrombomodulin Concentration and Early Markers of Atherosclerosis. J Interv Cardiol 2022; 2022:6152571. [PMID: 35855391 PMCID: PMC9286949 DOI: 10.1155/2022/6152571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Thrombomodulin, an integral membrane protein functioning as a cofactor in the anticoagulant pathways, has recently emerged as a marker of endothelial dysfunction. This study aimed to investigate the impact of laparoscopic sleeve gastrectomy (LSG) on thrombomodulin concentration and early markers of atherosclerosis. Methods Forty-four subjects undergoing LSG were prospectively examined. The change in thrombomodulin concentration from baseline (preoperative) to the sixth postoperative month following the LSG and the relationship between the change in thrombomodulin concentration and BMI, CIMT, ABI, and blood lipids were examined. Results The medical records were available for 44 patients (mean age: 37.2 ± 10.9 years, 65.9% male). LSG led to significant reductions in total body weight and body mass index (BMI) at postoperative six months (37.0 ± 5.6 kg/m2 vs. 47.1 ± 5.8 kg/m2, p < 0.001). Markers of early atherosclerotic events, including carotid intima-media thickness (CIMT) and ABI, improved. The change in thrombomodulin concentration (Δ TMD) was significantly correlated with the change in Δ BMI (r = 0.500, p=0.011), Δ LDL (r = 0.389, p=0.032), Δ systolic blood pressure (r = 0.384, p=0.012), and Δ CIMT (r = 0.327, p=0.012) and was negatively correlated with Δ HDL (r = −0.344, p=0.020) and Δ ABI (r = −0.357, p=0.020). Conclusion LSG leads to significant improvements in blood lipids, systolic and diastolic blood pressure, and in surrogate markers of atherosclerotic burden and endothelial function, including thrombomodulin, ABI, and CIMT, at postoperative six months. LSG might prevent or reduce atherogenesis in the early stages by stopping endothelial dysfunction.
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ÇAY F, SAHIN VURAL G. Evaluation of the alteration in retinal features following bariatric surgery in patients with morbid obesity. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1080209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The aim of the study is to evaluate the effect of bariatric surgery on the retina and choroid in non-diabetic and non-hypertensive patients with morbid obesity using optic coherence tomography (OCT) retrospectively.
Material and Method: Seventy-four eyes of seventy-four patients who have been underwent sleeve gasterectomy for morbid obesity in Balıkesir University Medicine Faculty & February 2019 and November 2020 were evaluated. All participants has a detailed ophthalmologic examination including best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, retinal examination through non-dilated pupil via 90 D fundus lens, the retinal thickness (central, perifoveal, and parafoveal superior/nasal/inferior/temporal quadrants), and choroidal thickness through optic coherence tomography (RTVue XR Avanti, Optovue) in immediate preoperative and postoperative sixth-month. All values were compared.
Results: The macular thickness was increased significantly in all quadrants in postoperative visits (p0.05). The correlation between preoperative BMI and preoperative choroidal thickness was significant (R: 0.416, p
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Affiliation(s)
- Ferhat ÇAY
- BALIKESİR ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
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9
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Gokce N, Karki S, Dobyns A, Zizza E, Sroczynski E, Palmisano JN, Mazzotta C, Hamburg NM, Pernar LI, Carmine B, Carter CO, LaValley M, Hess DT, Apovian CM, Farb MG. Association of Bariatric Surgery With Vascular Outcomes. JAMA Netw Open 2021; 4:e2115267. [PMID: 34251443 PMCID: PMC8276087 DOI: 10.1001/jamanetworkopen.2021.15267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
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 PARTICIPANTS This 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 A1c 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 RELEVANCE The 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 by metabolic status were identified, underscoring heterogeneity in physiological responses to adiposity change and potential activation of distinct pathological pathways in clinical subgroups. As such, individuals with metabolically healthy obesity represent a mixed population that may benefit from more refined phenotypic classification.
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Affiliation(s)
- Noyan Gokce
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Shakun Karki
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Alyssa Dobyns
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Elaina Zizza
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Emily Sroczynski
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Joseph N. Palmisano
- Department of Public Health, Boston University School of Medicine, Boston, Massachusetts
| | - Celestina Mazzotta
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Naomi M. Hamburg
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Luise I. Pernar
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Brian Carmine
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Cullen O. Carter
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Michael LaValley
- Department of Public Health, Boston University School of Medicine, Boston, Massachusetts
| | - Donald T. Hess
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Caroline M. Apovian
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Melissa G. Farb
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
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10
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Kornyushin OV, Sonin DL, Polozov AS, Masley VV, Istomina MS, Papayan GV, Mukhametdinova DV, Cheburkin YV, Toropova YG, Zelinskaya IA, Neimark AE, Derkach KV, Shpakov AO, Galagudza MM. Effects of three types of bariatric interventions on myocardial infarct size and vascular function in rats with type 2 diabetes mellitus. Life Sci 2021; 279:119676. [PMID: 34087285 DOI: 10.1016/j.lfs.2021.119676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
AIMS The effects of three types of bariatric interventions on myocardial infarct size were tested in the rat model of type 2 diabetes mellitus (T2DM). We also evaluated the effects of bariatric surgery on no-reflow phenomenon and vascular dysfunction caused by T2DM. MAIN METHODS Rats with T2DM were assigned into groups: without surgery, sham-operated, ileal transposition, Roux-en-Y gastric bypass, and sleeve gastrectomy. Oral glucose tolerance, glucagon-like peptide-1, and insulin levels were measured. Six weeks after surgery, the animals were subjected to myocardial ischemia-reperfusion followed by histochemical determination of infarct size (IS), no-reflow zone, and blood stasis area size. Vascular dysfunction was characterized using wire myography. KEY FINDINGS All bariatric surgery types caused significant reductions in animal body weight and resulted in T2DM compensation. All bariatric interventions partially normalized glucagon-like peptide-1 responses attenuated by T2DM. IS was significantly smaller in animals with T2DM. Bariatric surgery provided no additional IS limitation compared with T2DM alone. Bariatric surgeries reversed T2DM-induced enhanced contractile responses of the mesenteric artery to 5-hydroxytryptamine. Sleeve gastrectomy normalized decreased nitric oxide synthase contribution to the endothelium-dependent vasodilatation in T2DM. SIGNIFICANCE T2DM resulted in a reduction of infarct size and no-reflow zone size. Bariatric surgery provided no additional infarct-limiting effect, but it normalized T2DM-induced augmented vascular contractility and reversed decreased contribution of nitric oxide to endothelium-dependent vasodilatation typical of T2DM. All taken together, we suggest that this type of surgery may have a beneficial effect on T2DM-induced cardiovascular diseases.
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Affiliation(s)
- Oleg V Kornyushin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Dmitry L Sonin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Alexander S Polozov
- Laboratory of Physiology Nutrition, Pavlov Institute of Physiology RAS, Saint Petersburg, Russian Federation
| | - Vitaly V Masley
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Maria S Istomina
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Garry V Papayan
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Daria V Mukhametdinova
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Yuri V Cheburkin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Yana G Toropova
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Irina A Zelinskaya
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Alexander E Neimark
- Laboratory of Surgery for Metabolic Disorders, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation
| | - Kira V Derkach
- Laboratory of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russian Federation
| | - Alexander O Shpakov
- Laboratory of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Saint Petersburg, Russian Federation
| | - Michael M Galagudza
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.
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11
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The obesity paradox in the stress echo lab: fat is better for hearts with ischemia or coronary microvascular dysfunction. Int J Obes (Lond) 2020; 45:308-315. [PMID: 32830196 DOI: 10.1038/s41366-020-00655-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity is an independent risk factor for coronary artery disease (CAD), but once CAD has developed it has been associated with improved survival ("obesity paradox"). AIM To assess how obesity affects prognosis in patients with or without inducible ischemic regional wall motion abnormalities (RWMA) and/or abnormal coronary flow velocity reserve (CFVR) during stress echocardiography (SE). METHODS In an observational retrospective two- center study design, we analyzed 3249 consecutive patients (1907 men; age 66 ± 12 years; body mass index, BMI, 26.9 ± 4.1 kg/m2) with known (n = 1306) or suspected (n = 1943) CAD who underwent dipyridamole SE with simultaneous evaluation of RWMA and CFVR. All-cause death was the outcome end-point. RESULTS 1075 patients were lean (BMI 18.5-24.9 kg/m2), 1523 overweight (BMI 25.0-29.9 kg/m2), and 651 obese (≥30.0 kg/m2). Ischemic test result for RWMA occurred in 28 (3%) lean, 69 (4%) overweight, and 28 (4%) obese patients (p = 0.03). An abnormal CFVR (≤2.0) was found in 281 (26%) lean, 402 (26%) overweight and 170 (26%) obese patients (p = 0.99). During 68 ± 44 months of follow-up, 496 (15%) patients died. At multivariable Cox analysis, BMI ≥ 30 was an independent predictor of reduced mortality in the 878 patients with stress-induced (≥2 segments) RWMA and/or CFVR abnormality (HR 0.58, 95% CI 0.40-0.84; p = 0.003), while showed no effect at univariate analysis in the 2371 patients with no RWMA and normal CFVR (HR 1.04, 95% CI 0.74-1.46; p = 0.84). CONCLUSIONS Obesity exerts a "paradoxical" protective effect in patients with stress-induced ischemia and/ or coronary microvascular dysfunction, and shows a neutral effect in patients with normal CFVR and no stress-induced RWMA.
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12
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Laiginhas R, Guimarães M, Cardoso P, Santos-Sousa H, Preto J, Nora M, Chibante J, Falcão-Reis F, Falcão M. Bariatric Surgery Induces Retinal Thickening Without Affecting the Retinal Nerve Fiber Layer Independent of Diabetic Status. Obes Surg 2020; 30:4877-4884. [PMID: 32779075 DOI: 10.1007/s11695-020-04904-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Obese patients have neurodegeneration of the optic nerve demonstrated by decreased peripapillary nerve fiber layer. Whether bariatric surgery reverses this neurodegenerative process has not been explored. We aimed to evaluate the impact of bariatric surgery in the structure of the retina and optic nerve. METHODS Multicentric observational study. Obese patients scheduled for bariatric surgery were consecutively recruited and included in the study and evaluated before and 6-12 months after the intervention. The retinal structure was evaluated as retinal thickness in the different retinal layers in the foveal, perifoveal, and parafoveal regions using optical coherence tomography. Choroidal thickness and optic nerve retinal nerve fiber layer thickness were also evaluated. RESULTS Eighty eyes from 40 participants were included. Globally, we found a significant thickening of the retina after bariatric surgery (foveal: 273.5 (21.5) μm vs 280.0 (28.8) μm, p < 0.001; parafoveal 332.4 ± 17.8 μm vs 336.6 ± 15.9 μm, p = 0.003; perifoveal: 293.4 ± 13.8 μm vs 295.7 ± 14.9 μm; p = 0.001), whereas no significant differences were found for the ganglion cell layer, choroid, or peripapillary nerve fiber layer thickness. The retinal thickening was confined to inner retinal layers and was independent of the diabetic status of the patients. After multivariate adjustment, HbA1c variation, preoperative C-peptide, preoperative hypertension, preoperative OSA, and preoperative LDL and TG levels seem to be clinical predictors of retinal thickening. CONCLUSIONS We found a significant thickening of the retina after bariatric surgery that was independent of the diabetic status. The thickening was confined to inner retinal layers and may represent and improve perfusion. The peripapillary nerve fiber layer remained unchanged after the surgery.
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Affiliation(s)
- Rita Laiginhas
- PDICSS, Faculty of Medicine of Porto University (FMUP), Porto, Portugal.,Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Marta Guimarães
- Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal.,Department of Anatomy, Institute of Biomedical Science Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Pedro Cardoso
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Hugo Santos-Sousa
- Department of Surgery, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal
| | - John Preto
- Department of Surgery, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal
| | - Mário Nora
- Department of General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal.,Unit for Multidisciplinary Research in Biomedicine (UMIB), Endocrine, Cardiovascular and Metabolic Research, University of Porto, Porto, Portugal
| | - João Chibante
- Department of Ophthalmology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal. .,Department of Surgery and Physiology, Faculty of Medicine of Porto University (FMUP), 4200-319, Porto, Portugal.
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13
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Sanches E, Topal B, Proczko M, Stepaniak PS, Severin R, Phillips SA, Sabbahi A, Pujol Rafols J, Pouwels S. Endothelial function in obesity and effects of bariatric and metabolic surgery. Expert Rev Cardiovasc Ther 2020; 18:343-353. [DOI: 10.1080/14779072.2020.1767594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Elijah Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Monika Proczko
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Gdansk University, Gdansk, Poland
| | - Pieter S. Stepaniak
- Department of Operating Rooms, Catharina Hospital, Eindhoven, The Netherlands
| | - Rich Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Shane A. Phillips
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physical Therapy, Integrative Physiologic Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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14
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Streese L, Königstein K, Goricki L, Infanger D, Wölnerhanssen B, Peters T, Schmidt-Trucksäss A, Hanssen H. Short- and Long-Term Effects of Bariatric Surgery on Vascular Phenotype. Obes Surg 2020; 29:1301-1308. [PMID: 30617916 DOI: 10.1007/s11695-018-03679-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Retinal microvascular diameters and large artery stiffness are valid biomarkers of cardiovascular risk. This study assessed short- and long-term micro- and macrovascular improvements after bariatric surgery (BS). METHODS Sixteen patients (44 ± 12 years) underwent BS in this observational study. Two weeks before as well as 6 weeks and 4 years after surgery, retinal vessel analysis and assessment of brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI), and anthropometry were performed. Three patients were lost to follow-up. RESULTS Six weeks after BS, retinal arteriolar diameters (CRAE) were wider (180.1 μm vs. 188.1 μm; p = 0.001), and the arteriolar-to-venular diameter ratio (AVR) was higher (0.82 vs. 0.86; p < 0.001) compared to baseline levels. During the 4 years of follow-up, the retinal changes sustained but further improvements did not occur. Both indices of large artery stiffness, baPWV and CAVI, remained unchanged 6 weeks and 4 years after surgery. CONCLUSIONS Retinal microvascular phenotype improved 6 weeks after BS. The improvements in microvascular health were maintained during 4 years of follow-up but, despite significant further reductions in body mass index, did not improve further long-term. baPWV and CAVI were unaffected after surgery indicating that BS primarily affects microvascular phenotype rather than large artery stiffness. Retinal vessel imaging seems to be a feasible diagnostic tool to monitor microvascular health after BS. Normalization of BMI and blood pressure may be necessary to achieve long-term improvement of large artery phenotype after BS.
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Affiliation(s)
- Lukas Streese
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Birsstr. 320 B, 4052, Basel, Switzerland
| | - Karsten Königstein
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Birsstr. 320 B, 4052, Basel, Switzerland
| | - Lara Goricki
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Birsstr. 320 B, 4052, Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Birsstr. 320 B, 4052, Basel, Switzerland
| | | | - Thomas Peters
- St. Clara Research Ltd, St. Claraspital, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Birsstr. 320 B, 4052, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Division Sports and Exercise Medicine, University of Basel, Birsstr. 320 B, 4052, Basel, Switzerland.
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15
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Frey S, Jacobi D, Pichelin M, Cariou B, Mirallié E, Blanchard C. Improvement in arterial stiffness (pOpmètre®) after bariatric surgery. Results from a prospective study. ANNALES D'ENDOCRINOLOGIE 2020; 81:44-50. [PMID: 32081364 DOI: 10.1016/j.ando.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/16/2019] [Accepted: 01/22/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Arterial stiffness (AS) is an independent predictor of cardiovascular risk, and could be used as a surrogate marker of improvement in cardiovascular risk following bariatric surgery. The aim of this study was to compare AS before and after surgery. METHODS One hundred and thirty-four patients undergoing bariatric surgery between May 2016 and January 2019 were prospectively included. AS was measured on pulse wave velocity (PWV) with the pOpmètre® device pre- and postoperatively. The main endpoint was change in PWV between baseline and 3 months post-surgery. RESULTS Overall, mean PWV was 6.87m/s preoperatively and 6.71m/s at 3 months (P=0.7148). Patients with pathologic PWV (>2 standard deviations from expected value for age) showed significant improvement at 3 months (31 patients; 10.1m/s preoperatively vs 7.5m/s at 3 months; P=0.007). These results did not correlate with improvement in other clinical or biological parameters following surgery (excess weight loss, mean blood pressure, fasting blood glucose, waist circumference, body composition). CONCLUSION These results suggest that pathological arterial stiffness may resolve following bariatric surgery independently of the other factors influencing cardiovascular risk in obesity.
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Affiliation(s)
- Samuel Frey
- Chirugie cancérologique digestive et endocrinienne (CCDE), institut des maladies de l'appareil digestif (IMAD), CHU de Nantes-Hôtel Dieu, Nantes, France
| | - David Jacobi
- Department of Endocrinology, CHU de Nantes, Nantes, France; Inserm, CNRS, l'institut du thorax, Université Nantes, Nantes, France
| | - Matthieu Pichelin
- Department of Endocrinology, CHU de Nantes, Nantes, France; Inserm, CNRS, l'institut du thorax, Université Nantes, Nantes, France
| | - Bertrand Cariou
- Department of Endocrinology, CHU de Nantes, Nantes, France; Inserm, CNRS, l'institut du thorax, Université Nantes, Nantes, France
| | - Eric Mirallié
- Chirugie cancérologique digestive et endocrinienne (CCDE), institut des maladies de l'appareil digestif (IMAD), CHU de Nantes-Hôtel Dieu, Nantes, France
| | - Claire Blanchard
- Chirugie cancérologique digestive et endocrinienne (CCDE), institut des maladies de l'appareil digestif (IMAD), CHU de Nantes-Hôtel Dieu, Nantes, France; Inserm, CNRS, l'institut du thorax, Université Nantes, Nantes, France.
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16
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Borzì AM, Buscemi C, Corleo D, Randazzo C, Rosafio G, Pantuso G, Buscemi S. Endothelial Function in Obese Patients Treated with Bariatric Surgery. Diabetes Metab Syndr Obes 2020; 13:247-256. [PMID: 32099431 PMCID: PMC7007802 DOI: 10.2147/dmso.s230684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE 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 by-passes 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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Affiliation(s)
- Antonio Maria Borzì
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, Catania, Italy
- Specialization School in Geriatrics, Catania, Italy
| | - Carola Buscemi
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
| | - Davide Corleo
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
| | - Cristiana Randazzo
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
| | - Giuseppe Rosafio
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
| | - Gianni Pantuso
- Dipartimento di Discipline Chirurgiche e Odontostomatologiche (DICHIRONS), Unit of Chirurgia Oncologica, Policlinico University Hospital, Palermo, Italy
| | - Silvio Buscemi
- Dipartimento di Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palerno, Italy
- Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Palermo, Italy
- Correspondence: Silvio Buscemi Unit of Malattie Endocrine, del Ricambio e della Nutrizione, Policlinico University Hospital, Piazza delle cliniche 2, Palermo90127, Italy Email
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17
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Suhrs HE, Michelsen MM, Prescott E. Treatment strategies in coronary microvascular dysfunction: A systematic review of interventional studies. Microcirculation 2019; 26:e12430. [PMID: 29130567 DOI: 10.1111/micc.12430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022]
Abstract
CMD has been associated with a wide spectrum of diseases and conditions, and it has proven to be a strong prognostic marker of morbidity and mortality. Despite increased attention, guideline-based treatment recommendations are lacking. We performed a systematic review of pharmacological and nonpharmacological interventions to improve coronary perfusion, assessed by IC Doppler, TTDE, PET, CMRI, transthoracic contrast perfusion echocardiography, and dilution techniques. No restrictions were made regarding the study design (randomized, placebo-controlled/randomized with active comparators/nonrandomized with or without a control group), the cardiac condition studied, or the coronary microvascular function at baseline. An electronic database search yielded 4485 records of which 80 studies met our inclusion criteria. Included studies were sorted according to intervention and study design. Studies were small and heterogeneous in methodology, and only few were placebo-controlled. Although some treatments looked promising, we found that no specific treatment was sufficiently well documented to be recommended in any patient groups. There is a need for larger well-designed clinical trials, and we suggest that future studies stratify study populations according to pathogenic mechanisms, thereby investigating whether an individualized treatment approach would be more successful.
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Affiliation(s)
- Hannah E Suhrs
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - Marie M Michelsen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen NV, Denmark
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18
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Effect of liraglutide on body weight and microvascular function in non-diabetic overweight women with coronary microvascular dysfunction. Int J Cardiol 2019; 283:28-34. [PMID: 30773266 DOI: 10.1016/j.ijcard.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/27/2018] [Accepted: 12/03/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is associated with adverse cardiovascular outcomes and CMD is a hallmark of type 2 diabetes. Liraglutide improves cardiovascular prognosis through partly unknown mechanisms. We hypothesized that treatment with liraglutide improves CMD and symptoms through weight loss, in non-diabetic overweight patients with angina and no obstructive coronary artery disease (CAD). METHODS We included 33 non-diabetic overweight women (BMI > 25) with CMD (Coronary flow velocity reserve (CFVR) ≤2.5), angina symptoms and no obstructive CAD, in an open-label proof-of-concept study. The protocol included a control period of 5 weeks followed by an intervention period with liraglutide aiming at 3 mg daily for 12 weeks. Participants were investigated before and after the control period and again 1-2 weeks after last liraglutide dose. Primary outcomes were change in CFVR and change in angina symptoms measured by the Seattle Angina Questionnaire (SAQ) in the intervention period compared with the control period. (clinicaltrials.gov, NCT02602600, and ethically approved). RESULTS Twenty-nine participants completed the study. Liraglutide treatment led to a significant weight loss (mean 6.03 kg (95%CI: 5.22;6.84)) and decrease in systolic blood pressure (mean 10.95 mm Hg (95%CI: 4.60;17.30)). Baseline median CFVR was 2.30 (IQR 1.91;2.51) and remained unchanged after liraglutide treatment (mean change 0.07 (95%CI: -0.07;0.21)). There were no effects on symptoms measured by SAQ or parameters of left ventricular systolic as well as diastolic function. CONCLUSIONS Treatment with liraglutide led to significant weight loss and lowering of blood pressure with no concomitant symptoms alleviation during treatment and no improvement in coronary microvascular function.
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