Skip to main content
SpringerLink
Log in

The Role of Sleeve Gastrectomy in Reducing Cardiovascular Risk

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

An Erratum to this article was published on 14 November 2016

Abstract

Background

Obesity is an independent cardiovascular risk factor and a catalyst of other cardiovascular risk factors, such as hypertension, dyslipidemia, type 2 diabetes mellitus (DM2) and metabolic syndrome.

Methods

We analyzed cardiovascular risk in obese patients before and after sleeve gastrectomy (SG). To this end, we studied changes in body mass index (BMI), blood chemistry parameters that characterize the risk of atherosclerosis and instrumental parameters (objective markers of this risk), namely intima-media thickness (IMT) and flow-mediated dilation (FMD), the latter reflecting endothelial function. We also considered purely cardiac parameters—mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE)—which describe cardiac risk more specifically than the ejection fraction. Alteration of one or more of these parameters determines an increase in cardiovascular morbidity and mortality.

Results

The results showed that weight loss, in patients undergoing SG, is accompanied by a reduced BMI and a marked improvement in blood chemistry, confirming what has already been shown in many other studies, but the most interesting finding was the effect of SG on the instrumental markers of atherosclerosis. In particular, carotid IMT was significantly reduced (p < 0.001) and FMD significantly improved. MAPSE and TAPSE also improved significantly at both follow-up assessments (p < 0.001).

Conclusions

This study suggests that SG should be considered from a broader perspective, i.e. as a weight loss treatment that also improves obesity-related morbidity and mortality, benefitting both the patient and, in an economic sense, the society as a whole.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Eckel RH, Krauss RM. American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation. 1998;97(21):2099–100.

    Article  CAS  PubMed  Google Scholar 

  2. Sowers JR. Obesity as a cardiovascular risk factor. Am J Med. 2003;115(Suppl 8A):37S–41S.

    Article  CAS  PubMed  Google Scholar 

  3. Grundy SM. Obesity, metabolic syndrome, and cardiovascular disease. J Clin Endocrinol Metab. 2004;89:2595–600.

    Article  CAS  PubMed  Google Scholar 

  4. Hubert HB, Feinleib M, McNamara PM, et al. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67(5):968–77.

    Article  CAS  PubMed  Google Scholar 

  5. Chang HW, Li YH, Hsieh CH, et al. Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis. Cardiovasc Diagn Ther. 2016 Apr;6(2):109–19.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ghanim H, Aljada A, Hofmeyer D, et al. Circulating mononuclear cells in the obese are in a proinflammatory state. Circulation. 2004;110(12):1564–71.

    Article  CAS  PubMed  Google Scholar 

  7. Boido A, Ceriani V, Cetta F, et al. Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: mechanisms of action and choice of surgery. Nutr Metab Cardiovasc Dis. 2015 May;25(5):437–43.

    Article  CAS  PubMed  Google Scholar 

  8. Goday A, Benaiges D, Parri A, et al. Can bariatric surgery improve cardiovascular risk factors in the metabolically healthy but morbidly obese patient? Surg Obes Relat Dis. 2014 Sep-Oct;10(5):871–6.

    Article  PubMed  Google Scholar 

  9. Casella G, Abbatini F, Calì B, et al. Ten-year duration of type 2 diabetes as prognostic factor for remission after sleeve gastrectomy. Surg Obes Relat Dis. 2011 Nov-Dec;7(6):697–702.

    Article  PubMed  Google Scholar 

  10. Aloi M, Tromba L, Di Nardo G, et al. Premature subclinical atherosclerosis in pediatric inflammatory bowel disease. J Pediatr. 2012 Oct;161(4):589–94.

    Article  PubMed  Google Scholar 

  11. Aloi M, Tromba L, Rizzo V, et al. Aortic intima-media thickness as an early marker of atherosclerosis in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2015 Jul;61(1):41–6.

    CAS  PubMed  Google Scholar 

  12. Berni A, Giuliani A, Tartaglia F, et al. Effect of vascular risk factors on increase in carotid and femoral intima-media thickness. Identification of a risk scale. Atherosclerosis. 2011;216:109–14.

    Article  CAS  PubMed  Google Scholar 

  13. Verma S, Buchanan MR, Anderson TJ. Endothelial function testing as a biomarker of vascular disease. Circulation. 2003;108:2054–9.

    Article  PubMed  Google Scholar 

  14. Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Epidemiol. 1997;146:483–94.

    Article  CAS  PubMed  Google Scholar 

  15. O’Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999 Jan 7;340(1):14–22.

    Article  PubMed  Google Scholar 

  16. Adel W, Roushdy AM, Nabil M. Mitral annular plane systolic excursion-derived ejection fraction: a simple and valid tool in adult males with left ventricular systolic dysfunction. Echocardiography. 2016 Feb;33(2):179–84.

    Article  PubMed  Google Scholar 

  17. Matos J, Kronzon I, Panagopoulos G, et al. Mitral annular plane systolic excursion as a surrogate for left ventricular ejection fraction. J Am Soc Echocardiogr. 2012 Sep;25(9):969–74.

    Article  PubMed  Google Scholar 

  18. Nguyen T, Cao L, Movahed A. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential. Echocardiography. 2014 Oct;31(9):1159–65.

    Article  PubMed  Google Scholar 

  19. Allan PL, Mowbray PI, Lee AJ, et al. Relationship between carotid intima-media thickness and symptomatic and asymptomatic peripheral arterial disease. The Edinburgh Artery Study. Stroke. 1997 Feb;28(2):348–53.

    Article  CAS  PubMed  Google Scholar 

  20. Corretti MC, Anderson TJ, Benjamin EJ, et al. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002;39:257–65.

    Article  PubMed  Google Scholar 

  21. Nuzzo R. Scientific method: statistical errors. Nature. 2014 Feb 13;506(7487):150–2.

    Article  CAS  PubMed  Google Scholar 

  22. Goodman SN. Of P-values and Bayes: a modest proposal. Epidemiology. 2001;12(3):295–7.

    Article  CAS  PubMed  Google Scholar 

  23. Maggio CA, Pi-Sunyer FX. The prevention and treatment of obesity. Application to type 2 diabetes. Diabetes Care. 1997;20:1744–66.

    Article  CAS  PubMed  Google Scholar 

  24. Keaney Jr JF, Larson MG, Vasan RS, et al. Obesity and systemic oxidative stress: clinical correlates of oxidative stress in the Framingham Study. Arterioscler Thromb Vasc Biol. 2003;23(3):434–9.

    Article  CAS  PubMed  Google Scholar 

  25. Cavarretta E, Casella G, Calì B, et al. Cardiac remodeling in obese patients after laparoscopic sleeve gastrectomy. World J Surg. 2013 Mar;37(3):565–72.

    Article  PubMed  Google Scholar 

  26. Lupoli R, Di Minno MN, Guidone C, et al. Effects of bariatric surgery on markers of subclinical atherosclerosis and endothelial function: a meta-analysis of literature studies. Int J Obes. 2016 Mar;40(3):395–402.

    Article  CAS  Google Scholar 

  27. Domienik-Karłowicz J, Lisik W, Rymarczyk Z, et al. The short-term effect of bariatric surgery on non-invasive markers of artery function in patients with metabolic syndrome. Diabetol Metab Syndr. 2015 Sep 16;7:76.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lind L, Zethelius B, Sundbom M, et al. Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery. Int J Obes. 2009;33:1390–5.

    Article  CAS  Google Scholar 

  29. Tschoner A, Sturm W, Gelsinger C, et al. Long-term effects of weight loss after bariatric surgery on functional and structural markers of atherosclerosis. Obesity (Silver Spring). 2013;21:1960–5.

    Article  CAS  Google Scholar 

  30. Matthias W, Lorenz MD, et al. Prediction of clinical cardiovascular events with carotid IMT. A systematic review and meta-analysis. Circulation. 2007;115:459–67.

    Article  Google Scholar 

  31. Frazier DT, Seider T, Bettcher BM, et al. The role of carotid intima-media thickness in predicting longitudinal cognitive function in an older adult cohort. Cerebrovasc Dis. 2014;38(6):441–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Widlansky ME, Gokce N, Keaney F, et al. The clinical implications of endothelial dysfunction. J Am Coll Cardiol. 2003;42:1149–60.

    Article  CAS  PubMed  Google Scholar 

  33. Farb MG, Tiwari S, Karki S, et al. Cyclooxygenase inhibition improves endothelial vasomotor dysfunction of visceral adipose arterioles in human obesity. Obesity (Silver Spring). 2014 Feb;22(2):349–55.

    Article  CAS  Google Scholar 

  34. Tromba L, Tartaglia F, Blasi S, et al. Is carotid stenosis in women a gender-related condition? J Women’s Health (Larchmt). 2016;25(4):348–54.

    Article  Google Scholar 

Download references

Acknowledgments

Thanks to Mrs. Catherine Wrenn for her assistance and for the translation of the paper.

Author information

Authors and Affiliations

  1. Surgical Sciences Department, “Sapienza” University of Rome, Rome, Italy

    Luciana Tromba, Francesco Tartaglia, Sabino Carbotta, Nadia Sforza, Fabio Pelle & Giovanni Casella

  2. Gynecological, Obstetric Sciences Department and Urological Sciences, “Sapienza” University of Rome, Rome, Italy

    Vanessa Colagiovanni

  3. Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy

    Giovanni Carbotta

  4. CNR, IBB, Rome, Italy

    Stefania Cavaiola

Authors
  1. Luciana Tromba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Tartaglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sabino Carbotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nadia Sforza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabio Pelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vanessa Colagiovanni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giovanni Carbotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefania Cavaiola
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giovanni Casella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Tartaglia.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interests.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s11695-016-2456-x.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tromba, L., Tartaglia, F., Carbotta, S. et al. The Role of Sleeve Gastrectomy in Reducing Cardiovascular Risk. OBES SURG 27, 1145–1151 (2017). https://doi.org/10.1007/s11695-016-2441-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2441-4

Keywords

Search

Navigation