Improvement of Arterial Stiffness One Month after Bariatric Surgery and Potential Mechanisms

Abstract

Arterial stiffness (AS) is an independent predictor of cardiovascular risk. We aimed to analyze changes (Δ) in AS 1-month post-bariatric surgery (BS) and search for possible pathophysiological mechanisms. Patients with severe obesity (43% hypertensives) were prospectively evaluated before and 1-month post-BS, with AS assessed by pulse-wave velocity (PWV), augmentation index (AIx@75) and pulse pressure (PP). Ambulatory 24 h blood pressure (BP), anthropometric data, renin-angiotensin-aldosterone system (RAAS) components and several adipokines and inflammatory markers were also analyzed. Overall reduction in body weight was mean (interquartile range (IQR)) = 11.0% (9.6–13.1). A decrease in PWV, AIx@75 and PP was observed 1-month post-BS (all, p < 0.01). There were also significant Δ in BP, RAAS components, adipokines and inflammatory biomarkers. Multiple linear regression adjusted models showed that Δaldosterone was an independent variable (B coeff.95%CI) for final PWV (B = −0.003, −0.005 to 0.000; p = 0.022). Angiotensin-converting enzyme (ACE)/ACE2 and ACE were independent variables for final AIx@75 (B = 0.036, 0.005 to 0.066; p = 0.024) and PP (B = 0.010, 0.003 to 0.017; p = 0.01), respectively. There was no correlation between ΔAS and anthropometric changes nor with Δ of adipokines or inflammatory markers except high-sensitivity C-reactive protein (hs-CRP). Patients with PWV below median decreased PWV (mean, 95%CI = −0.18, −0.25 to −0.10; p < 0.001) and both AIx@75 and PP at 1-month, but not those with PWV above median. In conclusion, there is an improvement in AS 1-month post-BS that correlates with ΔBP and Δrenin-angiotensin-aldosterone components. The benefit is reduced in those with higher PWV.

The Effect of Bariatric Surgery on Microvascular Structure and Function, Peripheral Pressure Waveform and General Cardiovascular Risk: A Longitudinal Study

“…Similar to previous research [16,44,[54][55][56], our subjects have also shown a marked improvement in PWA parameters and, as such, a reduction of the general arterial stiffness (AS). Nevertheless, other studies did not find such changes in the AS.…”

“…Indeed, in their study, Jamialahmadi et al, have observed a significant decline of PWV, post-bariatric surgery [16]. It is well-known that AS may be one of the mechanisms by which obesity increases cardiovascular risk independently of traditional risk factors [55]. However, this parameters can be assessed using various methodologies.…”

The Pathophysiological Associations Between Obesity, NAFLD, and Atherosclerotic Cardiovascular Diseases

“…Furthermore, it was found that 5 % weight loss is associated with 27 % reduction in angiotensinogen levels, 43 % reduction in renin, 31 % decrease in aldosterone, 12 % decrease in ACE activity, and 20 % decrease in angiotensinogen expression in the adipose tissue [116]. Consistently, it has been observed that decreased arterial stiffness and blood pressure after bariatric surgery is associated with a significant reduction in plasma renin activity and plasma aldosterone [118,119].…”

Adipokines and Arterial Stiffness in Obesity

“…Weight loss, one month after bariatric surgery, in patients with severe obesity, significantly improved arterial stiffness. Changes in some components of RAAS were independent correlates for the final values of vascular parameters, suggesting the involvement of this system in obesity-associated arterial stiffness [ 112 ].…”