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Surgery and artery function

Surgery improves artery function in metabolic patients

In the group of patients with severe obesity and metabolic syndrome, the variables influencing pulse wave velocity were age and hsCRP concentration

A reduction in BMI resulting from bariatric surgery in patients with severe obesity and metabolic syndrome also improves functional markers of artery function and advantageous metabolic changes, according to researchers from the Medical University of Warsaw, Warsaw, Poland. The improvement in functional markers of artery function (NTG%) was correlated with change in triglyceride blood concentration. They report their findings in a paper, ‘The short-term effect of bariatric surgery on non-invasive markers of artery function in patients with metabolic syndrome’, published online in Diabetology & Metabolic Syndrome.

They write that the objective of the study was to determine whether severe obesity in women with metabolic syndrome leads to functional remodelling of arterial wall and change in the corresponding markers. At the same time they assessed the effect of body mass reduction on the above mentioned markers following bariatric surgery.

The study included 40 premenopausal, morbidly obese women undergoing qualification for bariatric surgery. The control group consisted of 15 people of middle age, 36±8.34 years, and average body weight of 60.72±5.12kg. The patients in the control group were matched for sex and age. In all patients included in the study, physical examination and medical interview as well as basic laboratory tests, electrocardiography and pulse wave velocity (PWV), flow- and nitroglycerin-mediated dilatation (FMD, NTG) assessments were performed.

All measurements of FMD and NTG were performed under fasting conditions, after at least 12h without smoking and withholding treatment with any vasodilators. The examination was performed twice (before and six months after surgery.

Outcomes

All surgical patients (40) presented with hypertension and during the course of the study, 30 (75%) patients received two or more antihypertensive drugs (including angiotensin converting enzyme inhibitors and diuretics); and 10 (25%) patients used only one antihypertensive agent (angiotensin converting enzyme inhibitor). In 11 (27.5%) patients, prediabetes was diagnosed, including six (15%) patients with impaired fasting glucose (IFG) and seven (17.5%) patients with impaired glucose tolerance (IGT) [13]. In two (5%) patients both of the above mentioned abnormalities were observed simultaneously. The patients with diagnosed type 2 diabetes mellitus were excluded from the study. Disorders of lipid metabolism were present in 22 (55%) patients and obstructive sleep apnoea of at most moderate severity was diagnosed in eight (20%) patients.

The results of comparative analysis of markers of artery function in patients qualified for bariatric surgery and in the control group were summarized in Table 1.

Table 1: Comparison of markers of artery function in patients qualified for bariatric surgery and in the control group

In severely obese patients the tendency to nitroglycerin-mediated vasodilation (21.47±8.31 % vs. 31.42±5.95; p<0.05) was lower. There were no differences between study populations in mean values of pulse wave velocity and flow-mediated dilatation.

A comparison of basic anthropometric and biochemical parameters in patients before and six months after bariatric surgery was presented in Table 2.

Table 2 Comparison of basic anthropometric and biochemical parameters in patients before (OB1) and 6 months after (OB2) bariatric surgery

Hyperinsulinemia was observed in 19 (47.5%) patients in OB1 group and in six (15%) patients in OB2 group. The index HOMA values of insulin resistance showed statistically significant differences between the groups (1.76; 0.35–24.80 vs. 3.31; 1.16–11.68; p<0.0001). The insulin resistance was diagnosed in 26 (67%) patients in OB1 group and in nice (22.5 %) patients in OB2 group.

In 18 patients six months after the surgery, the parameters diagnostic for insulin resistance got normal. HbA 1 C results showed statistically significant differences between the groups (5.35; 4.70–6.10 vs. 5.65; 5.20–6.60; p<0.0001). There were also statistically significant differences found in the total cholesterol, triglycerides and hsCRP concentrations. There were no differences in creatinine, HDL cholesterol and LDL cholesterol concentrations, as well as in GFR results.

The researchers report that there were statistically significant differences observed in the values of all investigated parameters (PWV, FMD, NTG). A comparison of markers of artery function in patients in OB1 and OB2 groups was presented in Table 3.

Table 3: A comparison of markers of artery function in patients before and 6 months after bariatric surgery

In the group of patients with normal body weight, a negative correlation between body fat mass and pulse wave velocity (r = −0.49, p=0.063) of borderline statistical significance was observed.

“In summary one should notice that non-invasive evaluation of functional markers of artery function and metabolic indicators implies their negative changes in the group of women with severe obesity as compared with healthy controls,” the authors conclude. “In obese patients following only short (six months) postoperative period, the improvement of functional markers of artery function and advantageous metabolic changes were observed…It is worth noticing that in the group of patients with severe obesity and metabolic syndrome, the variables influencing pulse wave velocity were age and hsCRP concentration. Further observation of investigated population is recommended.”

To access this paper, please click here

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