Bariatric Surgery‐Induced Changes in Intima‐Media Thickness and Cardiovascular Risk Factors in Class 3 Obesity: A 3‐Year Follow‐Up Study

Abstract

Objective The impact of weight loss induced by bariatric surgery (BS) and nonsurgical approaches on cardiovascular risk factors (CVRFs) has not been fully elucidated. We assessed the effects of BS and a nonsurgical approach on carotid intima‐media thickness (CIMT) and CVRFs in participants with class 3 obesity. Methods A total of 87 participants with obesity (59 women; 46 [37‐52] years old; BMI, 43 [40‐47]) and 75 controls were recruited; 21 (25%) participants with obesity underwent BS. BMI, blood pressure, cholesterol, triglycerides, fasting plasma glucose, C‐reactive protein, CIMT, and Framingham Risk Score were measured at baseline and at 3‐year follow‐up. Independent factors for reduction in CIMT were analyzed. The literature on the effects of BS and CIMT was reviewed. Results After BS, BMI decreased from 45.45 to 27.28 (P < 0.001), and mean CIMT decreased from 0.64 mm (0.56‐0.75 mm) to 0.54 mm (0.46‐0.65) mm (P < 0.012), equivalent to 0.005 mm/kg of weight lost. At 3‐year follow‐up, participants who had undergone BS had similar CIMT and CVRFs to the control group. No changes in CVRFs were seen related to the nonsurgical approach. BMI reduction after BS had the strongest independent association with decreased CIMT. Conclusions Weight loss after BS decreases CIMT and CVRFs in middle‐aged participants with class 3 obesity, resulting in CIMT similar to that observed in lean participants.

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 , …”

“… Subgroup analysis based on the follow-up period [ 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ] ( A ) and type of surgery [ 33 , 37 , 38 , 39 , 40 , 41 , 42 , 45 , 49 , 50 , 52 , 53 , 54 , 58 , 59 , 60 ] ( B ). …”

Effect of Bariatric Surgery on Metabolic Diseases and Underlying Mechanisms

“…Obesity is a risk factor for cardiovascular and cerebrovascular diseases, while bariatric surgery is protective of the heart and vasculatures. Bariatric surgery reduces the incidence of sudden large vascular diseases (defined as the first onset of acute myocardial infarction, unstable angina, percutaneous coronary intervention, coronary artery bypass grafting, ischemic stroke, hemorrhagic stroke, carotid stenting, or carotid endarterectomy) [ 39 , 40 , 41 , 42 ]. Astonishingly, many patients with pre-existing cardiovascular disease can reduce or completely discontinue their cardiovascular medications after undergoing bariatric surgery [ 43 ].…”

The metabolic phenotype of the patient influences the reduction in carotid intima-media thickness achieved following metabolic surgery

“… 3 Furthermore, patients that undergo BMS experience significant reductions in CIMT and CVR alongside decreases in body mass index (BMI). 4 Although the precise mechanisms mediating the reduction in CVR following BMS are not yet clear, roles for mediators such as vascular endothelial growth factor (VEGF)-A, subclinical inflammation, and adiposity-related substances have been proposed. 5 …”