Identification of adipose tissue-related predictors of the reduction in cardiovascular risk induced by metabolic surgery

Abstract

Objectives We aimed to determine whether parameters associated with adipose tissue (adipocyte density and the circulating concentrations of markers of adipose tissue pathology) predict cardiovascular risk (CVR) modification after metabolic surgery (MS). Methods We performed a case–control study of patients with morbid obesity who were candidates for MS. CVR was defined using flow-mediated dilation (FMD) and carotid intima media thickness (CIMT), which were measured during the 9 months following MS. Subgroups of CVR reduction were defined using the following cut-offs: CIMT 10% and/or a two-fold increase in FMD. Results We studied 40 patients with morbid obesity (mean age 44.5 years, 75% women, mean body mass index 46.4 kg/m2) and high prevalences of the metabolically unhealthy obesity phenotype, hypertension, and diabetes mellitus. A significant reduction in CVR was associated with lower vascular endothelial growth factor-A concentration (6.20 vs. 1.59 pg/mL, respectively), low adipocyte density in visceral adipose tissue (100 vs. 80 cells/field), low infiltration with CD68+ cells (18 vs. 8 cells/field) and higher concentrations of lipid peroxidation markers and malondialdehyde (313.7 vs. 405.7 ng/mL). Conclusion The characteristics of adipose tissue and the circulating concentrations of markers of adipose pathology might represent useful predictors of the reduction in CVR following MS. Clinical trial registration number: NCT0356198 ( https://clinicaltrials.gov )

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

“…Since most of the studies did not include a control group, they were not assessed for comparability. In case-control studies [ 34 , 47 ], the included studies met the selection and exposure criteria. Quality assessment of the selected studies is presented in Table 2 and Table 3 .…”

“… ( 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 ). …”

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

“…However, in our previous study, we showed that adipocyte size, the extent of adipose tissue vascularization, and the concentrations of leptin and VEGF-A play a role in the reduction in CVR following BMS. 5 In addition, cardiometabolic risk phenotypes have been shown to be related to particular features of adipose tissue dysfunction, body fat distribution, and low-level inflammation. 6 , 7 Therefore, in the present study, we aimed to determine whether specific metabolic phenotypes influence the reduction in CVR following BMS.…”

“… 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 …”