Relation of Cumulative Weight Burden to Vascular Endothelial Dysfunction in Obesity

doi:10.1016/j.amjcard.2007.07.055

The American Journal of Cardiology

Volume 101, Issue 1, 1 January 2008, Pages 98-101

https://doi.org/10.1016/j.amjcard.2007.07.055 Get rights and content

Although excess fat mass is linked to increased cardiovascular risk, the relation between vascular phenotype and degree of obesity in high weight categories is unknown. We examined brachial artery vasomotor responses using ultrasound in 203 consecutive patients with severe obesity (mean age 44 ± 11 years; body mass index [BMI] 46 ± 9 kg/m², range 30 to 72; and body weight 128 ± 29 kg, range 69 to 207). We studied a unique population in which 71% of subjects were characterized as morbidly obese (BMI ≥40 kg/m²), which included a 31% group of super-obese subjects (BMI ≥50 kg/m²). Brachial artery flow-mediated dilation (FMD) and nitroglycerin-mediated dilation were examined as measures of endothelium-dependent and -independent dilation, respectively, in relation to clinical, hemodynamic, and metabolic variables. Endothelial function was significantly impaired in the highest compared with the lowest tertile of body weight (FMD 6.5 ± 4.6% vs 9.8 ± 4.8%, p <0.001), whereas nitroglycerin-mediated dilation was similar in all groups. Univariate correlates of FMD were gender, weight, waist circumference, BMI, diastolic blood pressure, and creatinine. In multivariate analysis, weight was a strong independent significant predictor of FMD (β = −0.23, p = 0.005) in addition to gender. Within an overweight population, cumulative weight burden remains strongly linked to progressive arterial dysfunction. In conclusion, these results suggest that cardiovascular risks intensify with higher degrees of obesity and underscore the importance of therapeutic weight loss interventions.

Section snippets

Methods

We enrolled 216 consecutive obese men and women (body mass index [BMI] ≥30 kg/m², range 30 to 72), aged ≥18 years, from 2002 to 2006 receiving care at the Boston Medical Center Nutrition and Weight Management Center. This high-volume ambulatory center provides outpatient comprehensive dietary, medical, behavioral, or surgical treatments to promote lifestyle modification and weight loss. Patients with unstable medical conditions such as active coronary syndromes, heart failure, systemic

Results

A total of 203 patients (mean age 44 ± 11 years, 80% women) completed the study. All subjects were obese with average BMI 46 ± 9 kg/m² (range 30 to 72), total body weight 128 ± 29 kg (69 to 207), and waist circumference 130 ± 19 cm (94 to 180). As expected in this demographic group, nearly half the patients had hypertension and approximately 1/3 was diabetic. Using a HOMA-IR value of 1.7 as a cut-point, 74% of the study population exhibited insulin resistance.4, 5 Patient characteristics

Discussion

In the present study of severely obese patients, we demonstrated that body weight is a significant predictor of vascular dysfunction after adjusting for covariates in a population with morbid obesity. Most importantly, weight burden was strongly linked to arterial dysfunction without evidence for a limit in degrees of vascular impairment, lending support to the recognition that cardiovascular risk increases with higher degrees of obesity. Brachial artery FMD correlated with body weight, but not

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Devastating transient and permanent postoperative neurocognitive complications in previously healthy, low-risk patients have been observed after elective shoulder arthroscopy in the beach chair position (BCP). Continuous monitoring of cerebral oxygen saturation has been recommended to identify cerebral desaturation events (CDEs) and improve patient safety. However, the relatively high cost and limited availability of monitoring may not be cost-effective. More cost-effective and available measures, including the use of thigh-high compression stockings (CS), have been investigated. However, efficacy data of CS usage is limited, especially for obese patients, who have been shown to be at increased risk for CDEs. The purpose of this was study was to determine if the intraoperative addition of thigh-high compression stockings decreases the incidence, frequency, and magnitude of CDEs in obese patients undergoing shoulder arthroscopy in the BCP.
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The incidence of CDEs was equal between groups, with 9 patients (27%) in each experiencing desaturation events. The median number of CDEs per patient was 3 for the control group and 1 for patients wearing CS (P = .29). There was no difference between groups in terms of median time from induction of anesthesia to onset of CDE (P = .79), median time from upright positioning to onset of CDE (P = .60), mean CDE duration per patient (P = .22), and median cumulative CDE duration (P = .19). The median maximal desaturation from baseline was also not different between groups: 27.6% in the control group and 24.3% in the treatment group (P = .35).
The combination of thigh-high CS and SCDs did not decrease the incidence, frequency, or magnitude of CDEs in patients undergoing shoulder arthroscopy in the BCP. Twenty-seven percent of patients undergoing shoulder arthroscopy in the BCP demonstrated CDEs with or without the use of CS. Therefore, further research is required to identify cost-effective, minimally invasive, and universally available methods of decreasing the incidence of CDEs during this common surgical procedure.
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To determine if the use of thigh-high compression stockings could decrease the incidence of cerebral desaturation events (CDEs) in patients with a body mass index (BMI) of 30 kg/m² or greater undergoing shoulder arthroscopy in the beach-chair position (BCP).
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SaRHI has been associated with the presence of major cardiovascular risk factors [15] and can predict future adverse cardiovascular events [16]. ED in obese patients has been investigated in several studies [17], but endothelial function (EF) in morbidly obese patients remains controversial, reported as impaired in some studies [18] and preserved in others [19]. SaRHI has not been evaluated in the morbidly obese.
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More than 50% of the MOP, OP and OwP had a cIMT above the 75th percentile per age and gender. No differences in cIMT or saRHI were observed, although overweight and obese patients (OOP) had higher arterial rigidity compared with the morbid-obese patients. In a multivariate regression test, while cholesterol was the main determinant of cIMT in overweight and obese patients, glucose metabolism was the determinant in MOP.
More than half of the population have a cIMT above general population ranges. OwP, OP and MOP have similar cIMT and saRHI. However, OOP have greater arterial wall rigidity. Dysglycemia is the main factor associated with subclinical atherosclerosis in MOP.
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Moreover, obesity is a risk factor for more rapid CAC progression.119 Obesity is associated with other markers of vascular disease, such as increased carotid intima-medial thickness120 and impaired endothelial-dependent vasodilation.121 Young individuals with abdominal visceral adiposity seem to have more infiltrated macrophages in their atherosclerotic lesions.122
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¹: Dr. Gokce was supported by Grant R01 HL074097 from the National Institutes of Health, Bethesda, Maryland.

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Preventive cardiologyRelation of Cumulative Weight Burden to Vascular Endothelial Dysfunction in Obesity

Section snippets

Methods

Results

Discussion

Am J Prev Med

Methods Enzymol

Am J Cardiol

Am J Cardiol

Long-term ascorbic acid administration reverses endothelial vasomotor dysfunction in patients with coronary artery disease

Circulation

Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man

Diabetologia

Preventive cardiology
Relation of Cumulative Weight Burden to Vascular Endothelial Dysfunction in Obesity