European Heart Journal Advance Access published online on April 20, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp108
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Non-conventional markers of atherosclerosis before and after gastric banding surgery
1 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna, Austria
2 Department of Internal Medicine II, Division of Cardiology, University of Vienna, Vienna, Austria
3 Department of Internal Medicine II, Division of Angiology, University of Vienna, Vienna, Austria
4 Department of Internal Medicine III and Karl Landsteiner Institute, Division of Endocrinology and Nephrology, Hospital Hietzing, Vienna, Austria
5 Department of Internal Medicine, Division of Cardiology, University of Ulm, Ulm, Germany
6 1st Medical Department, Hanusch Hospital, Vienna, Austria
Received 12 June 2007; revised 28 February 2009; accepted 4 March 2009 * Corresponding author. Tel: +43 1 49150 2301, Fax: +43 1 49150 2309, Email: kurt.huber{at}wienkav.at
Aims: Obesity and type 2 diabetes are associated with increased cardiovascular risk and elevation of traditional and non-traditional risk markers. As bariatric surgery reduces overweight and improves metabolic derangement, we examined a cluster of established and emerging cardiovascular risk factors, such as soluble CD40 ligand (sCD40L) and lipoprotein-associated phospholipase A2 (Lp-PLA2), which might improve prediction of future cardiovascular events because of their more direct involvement in plaque destabilization.
Methods and results: Obese patients [n = 32, body mass index (BMI) 46.1 ± 5.9 kg/m2] underwent clinical examinations and blood sampling for measurement of glucose and lipid parameters as well as non-traditional cardiovascular risk markers, i.e. high-sensitivity C-reactive protein, plasminogen activator inhibitor-1 (PAI-1), soluble cellular adhesion molecules (CAM), MMP-2, MMP-9, CD40L, and Lp-PLA2 before and after 1 year following laparoscopic adjustable gastric banding (LAGB), respectively. In patients undergoing LAGB, blood pressure (P < 0.0001) and blood glucose (P = 0.02) were significantly lowered by approximately 16% as well as triglyceride levels by approximately 29% (P = 0.002). In addition to a decrease of the inflammatory and pro-thrombotic marker PAI-1 (P = 0.001), CAMs, and MMP-9 (P = 0.004) were reduced, whereas no change was observed for plasma levels of MMP-2, sCD40L, and Lp-PLA2 after LAGB, respectively. Individual changes in (ICAM-1) intercellular adhesion molecule-1 (
ICAM-1) were related to changes in insulin (fasting insulin) before and after LAGB (r = 0.36 and r = 0.38; both P = 0.04). E-selectin correlated positively with changes in BMI (r = 0.38; P = 0.04 and r = 0.36; P = 0.05), while Lp-PLA2 concentration was negatively correlated with BMI (r =–0.41; P = 0.02) after 1 year. Changes were comparable in both overweight diabetic and non-diabetic subjects.
Conclusion: LAGB not only induced weight loss but also an improvement in the subclinical pro-inflammatory state. However, concentrations of most of the non-traditional risk factors for plaque instability, i.e. MMP-9, sCD40L, and Lp-PLA2 remained unchanged.
Key Words: PAI-1 • Adhesion molecules • Lp-PLA2 • CD40 ligand • Morbid obesity • Bariatric surgery • Gastric banding