Effect of bariatric surgery on clinical, laboratory and cardiovascular risk factors

INTRODUCTION: The adoption of a healthy lifestyle is one of the most important strategies for the primary prevention of cardiovascular diseases. However, low adhesion rates constitute a major obstacle to treatment. In this scenario, bariatric surgery emerged as an interesting option to promote dietary restriction and have gained importance, not only as obesity treatment but also in the control of cardiovascular risk factors and possible mortality reduction. Data from literature has shown that the surgical strategies can promote deep structural modifications in gastrointestinal tract leading to increased satiety and insulin sensitivity. In diabetic patients, already associated with a higher cardiovascular risk, the surgery would be able to promote a very intense and acute effect on the markers related to the development of atherosclerosis. This procedure, such as a very definite event in time, can be very useful for the study and identification of mechanisms that are not fully established in the atherosclerotic process. AIM: To analyse laboratory, clinical and structural variables related to the development and progression of atherosclerosis in diabetic patients undergoing bariatric surgery. METHODS: Twenty diabetic individuals with a BMI between 28-35kg/m2 were randomized to bariatric surgery or clinical treatment and ten healthy subjects (normal BMI) represented the control group. All participants underwent clinical and biochemical tests on the same occasions , up to thirty days before the surgery, three and twenty-four months after surgery. On these occasions beyond the lipid profile and glucose, we determine the incretin hormones, adipokines. Evaluation of the amount of epicardial fat and the presence of hepatic steatosis will be performed only after two years, in conjunction of the other variables. RESULTS: In the baseline surgical group differ from clinical group showing a higher BMI, Glycaemia and Triglycerides. For this matter all results were adjusted to these variables so that it did not interfere with the interpretation of the results. At 3 months, surgical group presented significant differences such as reduction in BMI (33.4±2.6 vs. 27.4±2.8 kg/m2, p<0.001), triglycerides (369.5±324.6 vs. 130.8±43.1 mg/dL, p<0.001), Pro-insulin (12.72±9.11 vs. 1.76±1.14 pM, p<0.001), glycaemia (217±103.1 vs. 102±2, mg/dL, p <0.001), glycated haemoglobin (9.26±2.12 vs. 6.18±0.63 %, p<0.001), Total Cholesterol (182.9±45.4 vs. 139.8±13 mg/dl, p<0.001), RBP-4 (9.85±2.53 vs. 7.3±1.35 ng/ml, p<0.001) and increment in HDL-cholesterol (33.1±7.7 vs. 38.4±10.6 mg/dL, p<0.001), glucagon (7.4±7.9 vs. 10.2±9.7 pg/ml, p<0.001) and FGF-19 (74.1±45.8 vs. 237.3±234 pg/ml, p=0.001). Interestingly, pro-insulin, RBP-4, HbA1c and HDL-cholesterol levels in the surgical group achieved “control group” values after 3 months but FGF-19 levels were almost two fold the results in the healthy subjects (237±234 vs. 98±102,1 pg/ml). Clinical group did not differ from baseline according to clinical variables, and only glucagon had a significant reduction 3 months after the intervention (18.1±20.7 vs. 16.8±18.4 pg/ml, p<0.001). CONCLUSIONS: Our results showed that diabetic individuals when subjected to bariatric surgery showed profound metabolic, hormonal and clinical alterations, when compared to similar individuals subjected to optimized clinical treatment. This improvement seen just after tree months could represent an important cardiovascular risk reduction. Individually, the notable modification of FGF -19 values associated with the intervention should be studied in greater depth to understand its meaning and potential utility as a marker or as one of the protagonists in cardiovascular prevention mechanism.