Impact of Bariatric Surgery on Pulse Wave Velocity as a Measure of Arterial Stiffness: a Systematic Review and Meta-analysis

Banach

Almahmeed³

et al. 2022

Arch Med Sci

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IntroductionThis systematic review and meta-analysis focuses on PCSK9 changes in obese patients following bariatric surgery.Material and methodsA systematic literature search in four databases was performed.ResultsThe results of meta-analysis on 4 trials including 260 individuals demonstrated a remarkable decline of PCSK9 after bariatric surgery (WMD: -57.34 ng/ml, 95% CI: -87.97, -26.71, p<0.001; I2:96.25%). Consistently, a significant decrease of LDL-C after bariatric surgery (WMD: -22.57 mg/dl, 95% CI: -27.5, -17.574, p<0.001; I2: 86.35%) was observed.ConclusionsPCSK9 is reduced significantly after bariatric surgery. The decrease of PCSK9 might be utilized as an independent surrogate marker of improvement of ASCVD risk after bariatric surgery.

supporting

confidence: 93%

Impact of bariatric surgery on circulating PCSK9 levels as marker of cardiovascular disease risk: a meta-analysis

Banach

Almahmeed³

et al. 2022

Arch Med Sci

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“…It is well recognized that cardiovascular risk parameters improve following bariatric surgery [ 3 , 53 ], and one of these parameters would be the improvement in endothelial cell function that is reflected in the increase in FMD [ 13 ]. Furthermore, in another meta-analysis evaluating the impact of bariatric surgery on cardiovascular risk, we showed that pulse wave velocity (PWV), as a measure of arterial stiffness, favorably predicts subsequent cardiovascular outcomes [ 12 ]. In this study, the improvement in FMD was present at 6 months with enhanced improvement after 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…Bariatric surgery has been shown to increase life expectancy in individuals with elevated cardiovascular risk [ 4 ]. Endothelial dysfunction is an important factor in cardiovascular disease development and progression [ 5 , 6 , 7 ], and its clinical assessment has been proposed as a surrogate marker for cardiovascular risk stratification and disease prognosis [ 8 , 9 , 10 , 11 , 12 ]. Functional clinical evaluation of endothelial dysfunction can be determined noninvasively by flow mediated vasodilation (FMD) that represents a nitric oxide (NO)-mediated dilatation of conduit arteries, which is endothelium-dependent, through an induced increase in blood flow and shear stress [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Bariatric Surgery on Flow-Mediated Vasodilation as a Measure of Endothelial Function: A Systematic Review and Meta-Analysis

Alidadi

Atkin

et al. 2022

JCM

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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.

“…It has also been shown that bariatric surgery might prevent or slow atherogenesis in the early stages by breaking the vicious circle between inflammation and endothelial dysfunction [ 13 ]. Bariatric surgery also results in a decrease in pulse wave velocity (PWV), which might be used as an independent surrogate marker of ASCVD improvement [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Bariatric Surgery on Circulating Levels of Lipoprotein (a): A Meta-analysis

BioMed Research International

Reiner

Alidadi

et al. 2022

Self Cite

Background. Obesity, especially severe obesity, is associated with a higher risk of atherosclerotic cardiovascular disease (ASCVD) morbidity and mortality. Bariatric surgery is a durable and effective weight loss therapy for patients with severe obesity and weight-related comorbidities. Elevated plasma levels of lipoprotein (a) (Lp(a)) are causally associated with ASCVD. The aim of this meta-analysis was to analyze whether bariatric surgery is associated with Lp(a) concentrations. Methods. A literature search in PubMed, Scopus, Embase, and Web of Science was performed from inception to May 1st, 2021. A random-effects model and the generic inverse variance weighting method were used to compensate for the heterogeneity of studies in terms of study design, treatment duration, and the characteristics of the studied populations. A random-effects metaregression model was used to explore the association with an estimated effect size. Evaluation of funnel plot, Begg’s rank correlation, and Egger’s weighted regression tests were used to assess the presence of publication bias in the meta-analysis. Results. Meta-analysis of 13 studies including 1551 patients showed a significant decrease of circulating Lp(a) after bariatric surgery (SMD: -0.438, 95% CI: -0.702, -0.174, p < 0.001 , I 2 : 94.05%). The results of the metaregression did not indicate any significant association between the changes in Lp(a) and duration of follow-up after surgery, reduction in body mass index, or baseline Lp(a) concentration. The reduction in circulating Lp(a) was robust in the leave-one-out sensitivity analysis. Conclusion. Bariatric surgery significantly decreases circulating Lp(a) concentrations. This decrease may have a positive effect on ASCVD in obese patients.