Although bariatric surgery is linked to lower cardiovascular mortality, the mechanisms behind this link are unknown. Therefore, researchers of this study wanted to find out what factors are linked to vascular remodeling after bariatric surgery and how sex, race, and metabolic status affect microvascular and macrovascular outcomes.
This population-based longitudinal cohort included 307 people who underwent bariatric surgery for the study. Between December 11, 2001 and August 27, 2019, the participants were enrolled in Boston Medical Center's bariatric surgery program and gathered data required for the study. The analysis of the data took place in September of 2019.
Preoperatively, at baseline, and at least once postoperatively within 12 months following the bariatric intervention, flow-mediated dilation (FMD) and reactive hyperemia (RH) (as markers of macrovascular and microvascular function, respectively) and clinical factors were examined.
In this study, 307 obese people (mean [SD] age 42  years; 246 [80%] women; 199 [65%] White; mean [SD] body mass index 46 ) were enrolled. Across sex, ethnicity, and conventional metabolic syndrome categories, bariatric surgery was linked to considerable weight loss and enhanced macrovascular and microvascular function (mean [SD] pre- vs postsurgery weight: 126  kg vs 104  kg; P < .001; mean [SD] pre- vs postsurgery FMD: 9.1% [5.3] vs 10.2% [5.1]; P < .001; mean [SD] pre- vs postsurgery RH: 764%  vs 923% ; P < .001).
Adiposity indicators and numerous metabolic factors correlated most strongly with changes in vascular phenotype, depending on vascular territory. No changes in macrovascular function were observed in individuals with metabolically healthy obesity. Biomarker analysis employing high-sensitivity C-reactive protein plasma levels of more than 2 mg/dL identified people with metabolically healthy obesity and low-grade inflammation who benefited from weight loss surgery microvascularly.
The results of this study demonstrate that bariatric surgery is linked to weight loss and positive vasculature remodeling in a wide range of people with cardiovascular risk.