The short-term effect of bariatric surgery on non-invasive markers of artery function in patients with metabolic syndrome

Diabetology & Metabolic Syndrome

Piotr Pruszczyk²  Urszula Demkow³  Andrzej Chmura¹  Olga Dzikowska-Diduch²  Zuzanna Rymarczyk²  Wojciech Lisik¹  Justyna Domienik-Karłowicz² 

[1] Department of General Surgery and Transplantology, Medical University of Warsaw, Nowogrodzka 59, Warsaw, 02-005, Poland;Department of General Medicine and Cardiology, Medical University of Warsaw, Lindley’a 5, Warsaw, 02-005, Poland;Department of Laboratory Medicine and Clinical Immunology of Developmental Age, Medical University of Warsaw, Marszałkowska 24, Warsaw, 00-576, Poland

关键词: Endothelial dysfunction;    Pulse wave velocity;    Flow-mediated dilatation;    Body mass index;    Bariatric surgery;    Morbid obesity;   

Others  :  1225016
DOI  :  10.1186/s13098-015-0076-6

 received in 2015-04-04, accepted in 2015-09-09,  发布年份 2015

【 摘 要 】

Background

An improved understanding of the vascular function, measured in non-invasive way, in constantly growing group of patients at increased risk of cardiovascular events is necessary. To evaluate the effects of metabolic syndrome in morbidly obese patients and body mass reduction secondary to gastric bypass surgery on convenient and new non-invasive markers of artery function: pulse wave velocity (PWV), flow- and nitroglycerin-mediated dilatation (FMD, NTG).

Methods

There were 40 patients included into prospective study, who were qualified for bariatric surgery (OB1) and evaluated again 6 m after surgery (OB2). A control group (CG) consisted of 15 healthy women. A second control group (CG2) consisted of 15 women with grade 1 obesity. PWV, FMD, NTG were assessed.

Results

The reduction of BMI (kg/m ² ) from 47.73 ± 6.18 (OB1) to 35.22 ± 5.20 (OB2) was observed. The PWV turned out to be higher before bariatric surgery (OB1 vs. OB2 8.53 ± 1.76 vs. 7.82 ± 1.49 m/s; p < 0.001), however it was no different than PWV in CG. In OB1 group PWV showed correlation with age (r = 0.492, p = 0.001), HR (r = 0.324, p = 0.04), %FM (r = 0.328; p = 0.039), NTG% (r = −0.332, p = 0.036) as well as hsCRP (r = 0.394, p = 0.014). A multivariate analysis showed that the most significant factors influencing PWV were age (p = 0.0005) and hsCRP (p = 0.0014), pseudo R ²index 0.44365. The values of FMD differed between OB1 and OB2 groups (12.83 ± 5.15 vs. 17.52 ± 5.50 %; p < 0.0001), however, they were similar to results obtained in CG (14.45 ± 6.14 %; NS). The values of nitroglycerin-mediated dilatation differed between OB1 and OB2 groups (21.47 ± 8.31 vs. 28.54 ± 8.16 %; p < 0.0001) and were lower as compared with CG (31.42 ± 5.95 %; p = 0.0005).

Conclusion

Body mass reduction secondary to bariatric surgery in patients with severe obesity and metabolic syndrome results in improvement of functional markers of artery function and advantageous metabolic changes. The improvement in functional markers of artery function (NTG%) was correlated with change in triglyceride blood concentration.

【 授权许可】

   
2015 Domienik-Karłowicz et al.

【 参考文献 】

• [1]World Health Organization: Obesity. Preventing and managing the global epidemic (Who Technical Report Series). World Health Organisation.
• [2]Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, et al.: Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010, 363(23):2211-2219.
• [3]Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al.: Executive summary: heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation. 2010, 121(7):948-954.
• [4]de Koning L, Merchant AT, Pogue J, Anand SS: Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007, 28(7):850-856.
• [5]Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, et al.: Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg 2007, 17(2):260-270.
• [6]Ciccone MM, Scicchitano P, Zito A, Agati L, Gesualdo M, Mandolesi S, et al.: Correlation between coronary artery disease severity, left ventricular mass index and carotid intima media thickness, assessed by Radio-Frequency. Cardiovasc Ultrasound. 2011, 9(1):32.
• [7]Espeland MA, Tang R, Terry JG, Davis DH, Mercuri M, Crouse JR 3rd: Associations of risk factors with segment-specific intimal-medial thickness of the extracranial carotid artery. Stroke 1999, 30(5):1047-1055.
• [8]Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE: Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997, 96(5):1432-1437.
• [9]Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al.: ESH/ESC 2007 Guidelines for the management of arterial hypertension. Rev Esp Cardiol. 2007, 60(9):968.
• [10]Lekakis J, Abraham P, Balbarini A, Blann A, Boulanger CM, Cockcroft J, et al.: Methods for evaluating endothelial function: a position statement from the European Society of Cardiology Working Group on Peripheral Circulation. Eur J Cardiovasc Prev Rehabil 2011.
• [11]Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al.: 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007, 28(12):1462-1536.
• [12]Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, et al.: Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002, 39(2):257-265.
• [13]Diabetologiczne PT. Zalecenia kliniczne dotyczące postępowania u chorych na cukrzycę 2011. Diabetologia Praktyczna. 2011;12(Suplement A).
• [14]Nordstrand N, Gjevestad E, Dinh KN, Hofso D, Roislien J, Saltvedt E, et al.: The relationship between various measures of obesity and arterial stiffness in morbidly obese patients. BMC Cardiovasc Disord. 2011, 11:7.
• [15]Arkin JM, Alsdorf R, Bigornia S, Palmisano J, Beal R, Istfan N, et al.: Relation of cumulative weight burden to vascular endothelial dysfunction in obesity. Am J Cardiol. 2008, 101(1):98-101.
• [16]Benjamin EJ, Larson MG, Keyes MJ, Mitchell GF, Vasan RS, Keaney JF Jr, et al.: Clinical correlates and heritability of flow-mediated dilation in the community: the Framingham Heart Study. Circulation. 2004, 109(5):613-619.
• [17]Biasucci LM, Graziani F, Rizzello V, Liuzzo G, Guidone C, De Caterina AR, et al.: Paradoxical preservation of vascular function in severe obesity. Am J Med. 2010, 123(8):727-734.