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Early effects of gastric bypass on endothelial function, inflammation, and cardiovascular risk in obese patients

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An Erratum to this article was published on 30 April 2011

Abstract

Background

Obesity is associated with a chronic low-grade inflammatory state, insulin resistance, and endothelial dysfunction, all of which contribute to increased risk of cardiovascular disease. We hypothesized that gastric bypass would produce rapid improvements in endothelial function, reduce inflammation, and lead to a decrease in cardiovascular risk.

Methods

We performed a prospective study of morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB). Clinical data, biochemical markers of inflammation, and parameters indicative of cardiovascular risk were collected preoperatively and at 3 and 6 months postoperatively. Metabolic and inflammatory mediators that were quantified included C-reactive protein, fibrinogen, PAI-1, IL-6, IL-10, IL-1Ra, adiponectin, leptin, triglycerides, total cholesterol, HDL, LDL, glucose, insulin, and HbA1c. Brachial artery reactivity testing (BART) was performed to assess peripheral arterial endothelial function, and Framingham cardiovascular risk score (FRS) was calculated on all study participants pre- and postoperatively.

Results

Fifteen patients (11 female) were enrolled (age = 49.2 ± 10.4 years; BMI = 48.1 ± 5.3 kg/m2). Six months post RYGB, mean BMI decreased to 35.4 ± 4.5, corresponding to 51.7% excess weight loss (P < 0.001). Mean waist circumference decreased significantly from 132 cm at baseline to 110 cm at 3 months (P = 0.003) and 107 cm at 6 months (P < 0.001). Six months after RYGB, weight loss led to significant improvements in clinical parameters indicative of cardiovascular disease or risk, including brachial artery diameter, endothelial independent vasodilation, and FRS. Favorable improvements in the proinflammatory markers CRP (P = 0.01) and leptin (P = 0.005), the anti-inflammatory mediator adiponectin (P = 0.002), and insulin sensitivity (HOMA-IR, P = 0.007) were evident at 3 months. At 6 months, improvements in CRP, leptin, and fasting insulin were maintained and fibrinogen levels also decreased (P = 0.047). Adiponectin continued to increase at 6 months (P = 0.004).

Conclusion

Gastric bypass is associated with early reversal of endothelial dysfunction, a more favorable inflammatory milieu, and, most importantly, a reduction in cardiovascular risk.

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Acknowledgment

This study was supported by a SAGES research grant.

Disclosures

Dr. Brethauer is a speaker, consultant, and scientific advisory board member for Ethicon Endo-Surgery, a speaker for Covidien, and receives research support from Bard/Davol. Dr. Schauer is a consultant and scientific advisory board member of and has received research support from Ethicon Endo-Surgery; is on the board of directors of Remedy MD; is on the scientific advisory board of and has received an educational grant from Stryker Endoscopy; is on the scientific advisory board of and is a consultant for Bard/Davol; is a consultant for and has received an educational grant from Gore; has received an educational grant from Baxter; is on the scientific advisory board of Barosense, Surgiquest, Cardinal/Snowden Pencer; has received an educational grant from Covidien; an educational grant from Allergan; and is on the board of directors of Surgical Excellence LLC. Hazel Huang and Drs. Heneghan, Eldar, Gatmaitan, Kashyap, Kirwan, and Gornik have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Bariatric and Metabolic Institute, M61, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Stacy A. Brethauer, Helen M. Heneghan, Shai Eldar, Patrick Gatmaitan & Philip R. Schauer

  2. Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Hazel Huang & John P. Kirwan

  3. Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Sangeeta Kashyap

  4. Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Heather L. Gornik

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  1. Stacy A. Brethauer
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  2. Helen M. Heneghan
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  9. Philip R. Schauer
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Correspondence to Stacy A. Brethauer.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00464-011-1732-z

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Brethauer, S.A., Heneghan, H.M., Eldar, S. et al. Early effects of gastric bypass on endothelial function, inflammation, and cardiovascular risk in obese patients. Surg Endosc 25, 2650–2659 (2011). https://doi.org/10.1007/s00464-011-1620-6

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