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Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery

International Journal of Obesity volume 33, pages 1390–1395 (2009)Cite this article

Abstract

Background:

Obesity is associated with increased risk of cardiovascular disease. We investigated vasoreactivity in conduit and resistance arteries in morbidly obese subjects, and the effect of weight loss after gastric bypass surgery.

Methods:

A total of 19 obese subjects (body mass index (BMI): 43.8±3.1 kg m−2, 75% female, mean age 41 years) were investigated before surgery and after 1 and 12 months of surgery. Nineteen non-obese controls matched for age and gender were examined. Vasoreactivity was evaluated by ultrasound to measure flow-mediated dilation (FMD, evaluating a conduit vessel) and pulse-wave analysis with terbutaline provocation (change in reflectance index (RI), evaluating resistance vessels).

Results:

Before surgery, the obese showed a low change in RI (18±12 vs 37±15% in controls, P=0.0001), but not significantly regarding FMD (7.9±6.4 vs 8.9±5.4% in controls). Surgery resulted in a weight loss of 9% at 1 month and 30% at 1 year. Change in RI markedly improved to 36±12% at 1 month (P=0.0001 vs baseline) and further to 44±11% at 1 year (P=0.014 vs 1 month). FMD did not change significantly. Heart rate and brachial artery diameter were reduced, with no significant change in blood pressure. The improvement in resistance vessel vasodilation, estimated as change in RI, was not correlated to changes in weight or measures of glucose and lipid metabolism.

Conclusions:

Obese patients showed impaired vasoreactivity in resistance arteries that was normalized already 1 month after gastric bypass surgery. The basis for this remarkable outcome, not significantly related to changes in body weight and metabolic variables, remains to be clarified.

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References

  1. Sjöström L . Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes (Lond) 2008; 32 (Suppl 7): S93–S97.

    Article  Google Scholar 

  2. Karlsson J, Taft C, Rydén A, Sjöström L, Sullivan M . Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes (Lond) 2007; 31: 1248–1261.

    Article  CAS  Google Scholar 

  3. Ludmer PL, Selwyn AP, Shock TL, Wayne RR, Mudge GH, Alexander RW et al. Pradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med 1986; 315: 1046–1051.

    Article  CAS  PubMed  Google Scholar 

  4. Schillaci G, Pirro M, Vaudo G, Gemelli F, Marchesi S, Porcellati C et al. Prognostive value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol 2004; 43: 1817–1822.

    Article  PubMed  Google Scholar 

  5. Schachinger V, Britten MB, Zeiher AM . Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000; 101: 1899–1906.

    Article  CAS  PubMed  Google Scholar 

  6. Linder L, Kiowski W, Buhler FR, Lüscer TF . Indirect evidence for the release of endothelium-derived relaxing factor in the human forearm circulation in vivo: blunted response in essential hypertension. Circulation 1990; 81: 1762–1767.

    Article  CAS  PubMed  Google Scholar 

  7. Panza JA, Quyyumi AA, Brush Jr JE, Epstein SE . Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension. N Engl J Med 1990; 323: 22–27.

    Article  CAS  PubMed  Google Scholar 

  8. Creager MA, Cooke JP, Medelsohn ME, Gallagher SJ, Coleman SM, Loscalzo J et al. Impaired vasodilation of forearm resistance vessels in hypercholesterolemic humans. J Clin Invest 1990; 86: 228–234.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Johnstone MT, Creager SJ, Scales KM, Cusco JA, Lee BK, Creager MA . Impaired endothelium-dependent vasodilation in patients with insulin-dependent diabetes mellitus. Circulation 1993; 88: 2510–2516.

    Article  CAS  PubMed  Google Scholar 

  10. Celermajer DS, Sörensen KE, Bull C, Robinson J, Deanfield JH . Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol 1994; 24: 1468–1474.

    Article  CAS  PubMed  Google Scholar 

  11. Lind L, Hall J, Larsson A, Annuk M, Fellström B, Lithell H . Evaluation of endothelium-dependent vasodilation in the human peripheral circulation. Clin Physiol 2000; 20: 440–448.

    Article  CAS  PubMed  Google Scholar 

  12. Lind L, Hall J, Johansson K . Evaluation of four different methods to measure endothelium-dependent vasodilation in the human peripheral circulation. Clin Sci 2002; 102: 561–567.

    Article  Google Scholar 

  13. Lind L, Fors N, Hall J, Marttala K, Stenborg A . A comparison of three different methods to evaluate endothelium-dependent vasodilation in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Arterioscler Thromb Vasc Biol 2005; 25: 2368–2375.

    Article  CAS  PubMed  Google Scholar 

  14. Wilkinson IB, Hall IR, MacCallum H, Mackenzie IS, McEniery CM, van der Arend BJ et al. Pulse wave analysis. Clinical evaluation of a noninvasive, widely applicable method for assessing endothelial function. Arterioscler Thomb Vasc Biol 2002; 22: 147–152.

    Article  CAS  Google Scholar 

  15. Hayward CS, Kraidly M, Webb CN, Collins P . Assessment of endothelial function using peripheral waveform analysis. A clinical application. J Am Coll Cardiol 2002; 40: 521–528.

    Article  CAS  PubMed  Google Scholar 

  16. Lind L, Pettersson K, Johansson K . Analysis of endothelium-dependent vasodilation by use of the radial artery pulse wave obtained by applanation tonometry. Clin Physiol Funct Imaging 2003; 23: 50–57.

    Article  PubMed  Google Scholar 

  17. Park SH, Shim KW . Reduction in visceral adiposity is highly related to improvement in vascular endothelial dysfunction among obese women: an assessment of endothelial function by radial artery pulse wave analysis. Yonsei Med J 2005; 46: 511–518.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Suh HS, Park YW, Kang JH, Lee SH, Lee HS, Shim KW . Vascular endothelial dysfunction tested by blunted response to endothelium-dependent vasodilation by salbutamol and its related factors in uncomplicated pre-menopausal obese women. Int J Obes (Lond) 2005; 29: 217–222.

    Article  CAS  Google Scholar 

  19. Brook RD, Bard RL, Rubenfire M, Ridker PM, Rajagopalan S . Usefulness of visceral obesity (waist/hip ratio) in predicting vascular endothelial function in healthy overweight adults. Am J Cardiol 2001; 88: 1264–1269.

    Article  CAS  PubMed  Google Scholar 

  20. Perticone F, Ceravolo R, Candigliota M, Ventura G, Iacopino S, Sinopoli F et al. Obesity and body fat distribution induce endothelial dysfunction by oxidative stress: protective effect of vitamin C. Diabetes 2001; 50: 159–165.

    Article  CAS  PubMed  Google Scholar 

  21. Arcaro G, Zamboni M, Rossi L, Turcato E, Covi G, Armellini F et al. Body fat distribution predicts the degree of endothelial dysfunction in uncomplicated obesity. Int J Obes Relat Metab Disord 1999; 23: 936–942.

    Article  CAS  PubMed  Google Scholar 

  22. Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G, Baron AD . Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance. J Clin Invest 1996; 97: 2601–2610.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Williams IL, Chowienczyk PJ, Wheatcroft SB, Patel AG, Sherwood RA, Momin A et al. Endothelial function and weight loss in obese humans. Obes Surg 2005; 15: 1055–1060.

    Article  PubMed  Google Scholar 

  24. Gokce N, Vita JA, McDonnell M, Forse AR, Istfan N, Stoeckl M et al. Effect of medical and surgical weight loss on endothelial vasomotor function in obese patients. Am J Cardiol 2005; 95: 266–268.

    Article  PubMed  Google Scholar 

  25. Pontiroli AE, Pizzocri P, Paroni R, Folli F . Sympathetic overactivity, endothelial dysfunction, inflammation, and metabolic abnormalities cluster in grade III (World Health Organization) obesity: reversal through sustained weight loss obtained with laparoscopic adjustable gastric banding. Diabetes Care 2006; 29: 2735–2738.

    Article  PubMed  Google Scholar 

  26. Sundbom M, Gustavsson S . Randomized clinical trial of hand-assisted laparoscopic versus open Roux-en-Y gastric bypass for the treatment of morbid obesity. Br J Surg 2004; 91: 418–423.

    Article  CAS  PubMed  Google Scholar 

  27. Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA et al. Guidlines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report from the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002; 39: 257–265.

    Article  PubMed  Google Scholar 

  28. Johansson L, Roos M, Kullberg J, Weis J, Ahlström H, Sundbom M et al. Lipid mobilization following Roux-en-Y gastric bypass examined by magnetic resonance imaging and spectroscopy. Obes Surg 2008; 18: 1297–1304.

    Article  CAS  PubMed  Google Scholar 

  29. Lind L, Johansson L, Hulthe J, von Below C, Ahlström H . Vasodilation and visceral fat in elderly subjects. The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis 2007; 194: e64–e71.

    Article  CAS  PubMed  Google Scholar 

  30. Suh HS, Park YW, Kang JH, Lee SH, Lee HS, Shim KW . Vascular endothelial dysfunction tested by blunted response to endothelium-dependent vasodilation by salbutamol and its related factors in uncomplicated pre-menopausal obese women. Int J Obes (Lond) 2005; 29: 217–222.

    Article  CAS  Google Scholar 

  31. Lind L . Endothelium-dependent vasodilation, insulin resistance and the metabolic syndrome in an elderly cohort: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis 2008; 196: 795–802.

    Article  CAS  PubMed  Google Scholar 

  32. Maser RE, Lenhard MJ, Irgau I, Wynn GM . Impact of surgically induced weight loss on cardiovascular autonomic function: one-year follow-up. Obesity (Silver Spring) 2007; 15: 364–369.

    Article  Google Scholar 

  33. Sarabi M, Lind L . Mental stress opposes endothelium-dependent vasodilation in young healthy individuals. Vasc Med 2001; 6: 3–7.

    Article  CAS  PubMed  Google Scholar 

  34. Eriksson M, Johansson K, Sarabi M, Lind L . Mental stress impairs endothelial vasodilatory function by a beta-adrenergic mechanism. Endothelium 2007; 14: 151–156.

    Article  CAS  PubMed  Google Scholar 

  35. Williams IL, Chowienczyk PJ, Wheatcroft SB, Patel A, Sherweed R, Momin A et al. Effect of fat distribution on endothelial-dependent and endothelial-independent vasodilatation in healthy humans. Diabetes Obes Metab 2006; 8: 296–301.

    Article  CAS  PubMed  Google Scholar 

  36. Raitakari M, Ilvonen T, Ahotupa M, Lehtimäki T, Harmoinen A, Suominen P et al. Weight reduction with very-low-caloric diet and endothelial function in overweight adults: role of plasma glucose. Arterioscler Thromb Vasc Biol 2004; 24: 124–128.

    Article  CAS  PubMed  Google Scholar 

  37. Skilton MR, Sieveking DP, Harmer JA, Franklin J, Loughnan G, Nakhla S et al. The effects of obesity and non-pharmacological weight loss on vascular and ventricular function and structure. Diabetes Obes Metab 2008; 10: 874–884.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Margareta Ericson for excellent laboratory work; Ing-Marie Carlsson for excellent secretarial assistance; and the Ernfors Fond and Uppsala University Funds for support.

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Authors and Affiliations

  1. Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden

    L Lind, B Edén Engström & F A Karlsson

  2. Department of Public Health and Caring Sciences/Geriatrics and Outpatient Clinic for Obesity Care, Uppsala University Hospital, Uppsala, Sweden

    B Zethelius

  3. Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden

    M Sundbom

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  1. L Lind
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  2. B Zethelius
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  3. M Sundbom
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  4. B Edén Engström
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  5. F A Karlsson
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Correspondence to F A Karlsson.

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Lind, L., Zethelius, B., Sundbom, M. et al. Vasoreactivity is rapidly improved in obese subjects after gastric bypass surgery. Int J Obes 33, 1390–1395 (2009). https://doi.org/10.1038/ijo.2009.188

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