The Effect of Laparoscopic Sleeve Gastrectomy on Subclinical Atherosclerosis in Patients with Severe Obesity

Epicardial Adipose Tissue: A Precise Biomarker for Cardiovascular Risk, Metabolic Diseases, and Target for Therapeutic Interventions

Epicardial adipose tissue (EAT) is located between the heart muscle and visceral pericardium, where it has direct contact with coronary blood vessels. Elevated thickness of this tissue can induce local inflammation affecting the myocardium and the underlying coronary arteries, contributing to various cardiovascular diseases such as coronary artery disease, atrial fibrillation, or heart failure with preserved ejection fraction. Recent studies have identified EAT thickness as a simple and reliable biomarker for certain cardiovascular outcomes. Examples include the presence of atherosclerosis, incident cardiovascular disease (CVD) in individuals with type 2 diabetes mellitus (T2DM), and the prevalence of atrial fibrillation. Furthermore, EAT measurements can help to identify patients with a higher risk of developing metabolic syndrome. Since the EAT thickness can be easily measured using echocardiography, such examinations could serve as a useful and cost-effective preventive tool for assessing cardiovascular health. This review also summarizes therapeutical interventions aimed at reducing EAT. Reducing EAT thickness has been shown to be possible through pharmacological, surgical, or lifestyle-change interventions. Pharmaceutical therapies, including thiazolidinediones, glucagon-like peptide 1-receptor agonists, sodium-glucose cotransporter 2 inhibitors, dipeptidyl peptidase-4 inhibitors, and statins, have been shown to influence EAT thickness. Additionally, EAT thickness can also be managed more invasively through bariatric surgery, or noninvasively through lifestyle changes to diet and exercise routines.

New insights on the association of weight loss with the reduction in carotid intima-media thickness among patients with obesity: an updated systematic review and meta-analysis

OBJECTIVES

Carotid intima-media thickness (CIMT) is a noninvasive marker of atherosclerosis, a typical pathologic process underlying cardiovascular diseases (CVDs). It is essential to explore the relationships between weight loss and the reduction of CIMT.

STUDY DESIGN

This was an updated systematic review and meta-analysis.

METHODS

A systematic literature search was conducted to collect relevant clinical trials. The pooled results of meta-analyses were assessed by weighted mean difference (WMD) and the corresponding 95 % confidence interval (95% CI).

RESULTS

Thirty-three articles involving 2273 participants were collected in this meta-analysis. Among all participants with obesity, the pooled mean of weight loss was -23.26 kg (95% CI: -27.71 to -18.81), and the pooled mean change of CIMT was -0.06 mm (95% CI: -0.08 to -0.04). Compared with Non-surgical interventions, Surgical ones could lead to much higher weight loss (Pbetween groups < 0.001). A more significant CIMT reduction was identified among Surgical intervention patients than among Non-surgical intervention participants (Pbetween groups < 0.001).

CONCLUSIONS

Effective interventions, especially Surgical interventions, could reduce the weight of patients with obesity, followed by the decline of CIMT, which might further disturb atherosclerosis progression and lower CVD risk.

Epicardial Adipose Tissue Changes After Bariatric and Metabolic Surgery: a Systematic Review and Meta-analysis

Epicardial adipose tissue (EAT) is a visceral fat depot located between the myocardium and visceral epicardium. Emerging evidence suggests that excessive EAT is linked to increased risk of cardiovascular conditions and other metabolic diseases. A literature search was conducted from the earliest studies to the 26th of November 2022 on PubMed, Embase, and the Cochrane. All the studies evaluating changes in EAT, pericardial adipose tissue (PAT), or total cardiac fat loss before and after BS were included. From 623 articles, 35 were eventually included in the systematic review. Twenty-one studies showed a significant reduction of EAT after BS, and only one study showed a non-significant reduction (p = 0.2).

Impact of bariatric surgery on carotid intima-media thickness, flow-mediated dilation, and nitrite-mediated dilation: a systematic review and meta-analysis

Obesity is considered one of the independent risk factors for atherosclerosis and is strongly correlated with cardiovascular morbidity and mortality. Previous studies showed carotid intima-media thickness (CIMT), flow-mediated dilation (FMD), and nitrite-mediated dilatation (NMD) are reliable non-invasive markers of arterial damage and dysfunction. The aim of this study was to evaluate the effect of bariatric surgery on CIMT, FMD, and NMD markers in patients with obesity. A systematic search was performed in the PubMed, Embase, Scopus, and Web of Science databases until May 2022. All the English-published studies on the effect of bariatric surgery on CIMT, FMD, and NMD were included. A quantitative meta-analysis was performed, as well as subgroup analyses for the type of procedure and duration of follow-up. Meta-analysis of 41 studies with 1639 patients showed CIMT was significantly reduced by .11 mm after bariatric surgery (95% CI, -.14 to -.08; P < .001; mean follow-up = 10.8 mo). The pooled analysis of 23 studies with 1106 patients showed an increase of FMD by 4.57% after bariatric surgery (95% CI, 2.69-6.44; P < .001; mean follow-up = 11.5 mo). The results of a pooled analysis of 12 studies with 346 patients showed a significant increase of NMD by 2.46% after bariatric surgery (95% CI, .99-3.94; P < .001; mean follow-up = 11.4 mo). The random effect meta-regression demonstrated that baseline CIMT and FMD significantly affect the changes in CIMT and FMD. This meta-analysis showed bariatric surgery can improve CIMT, FMD, and NMD markers in patients with obesity. These improvements show the known effect of metabolic surgery in decreasing cardiovascular risk.

Effect of bariatric surgery on carotid intima-media thickness: A meta-analysis based on observational studies

Objective

This meta-analysis aimed to investigate the effect of bariatric surgery on CIMT in people with obesity.

Methods

PubMed, Web of Science, Embase, and the Cochrane Library were searched for observational studies assessing the effect of bariatric surgery on CIMT from inception to August 2022. Mean difference (MD) and 95% confidence intervals were calculated to assess CIMT.

Results

A total of 23 studies, including 1,349 participants, were eligible to participate in this meta-analysis. The results revealed that CIMT was significantly decreased at 6 months, 12 months, and more than 18 months after bariatric surgery compared with baseline (6 months: MD = 0.09; P < 0.01; 12 months: MD = 0.12; P < 0.01; more than 18 months: MD = 0.14; P = 0.02). Meanwhile, laparoscopic Roux-en-Y gastric bypass (LRYGB) seemed to be more effective than laparoscopic sleeve gastrectomy (LSG) in lowering CIMT in terms of the type of surgery (LSG: MD = 0.11; P < 0.01; LRYGB: MD = 0.14; P < 0.01). Lastly, the benefits of bariatric surgery on CIMT was independent of gender (Male: MD = 0.06; P = 0.04; Female: MD = 0.08; P = 0.03).

Conclusions

Bariatric surgery is consistently effective in reducing CIMT in people with obesity.

The Impact of Bariatric Surgery on Cardiac Structure, and Systolic and Diastolic Function in Patients with Obesity: A Systematic Review and Meta-analysis

The purpose of this study was to provide pooled data from all studies on the impact of bariatric surgery on cardiac structure, and systolic and diastolic function evaluated by either echocardiography or cardiac magnetic resonance. PubMed, Web of Science, Embase, and Scopus databases were searched. Almost all of cardiac left-side structural indices improved significantly after bariatric surgery. However, right-side structural indices did not change significantly. Left ventricular ejection fraction and most of the diastolic function indices improved significantly after the bariatric surgery. The subgroup analysis showed that the left ventricular mass index decreased more in long-term follow-up (≥ 12 months). In addition, subgroup analysis of studies based on surgery type did not reveal any difference in outcomes between gastric bypass and sleeve gastrectomy groups.

Cardiac fat pat change after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis

Cardiac fat pad is a metabolically active organ that plays a role in energy homeostasis and cardiovascular diseases and generates inflammatory cytokines. Many studies have shown remarkable associations between cardiac fat thickness and cardiovascular diseases, making it a valuable target for interventions. Our meta-analysis aimed to investigate the effects of the 2 most popular bariatric surgeries (sleeve gastrectomy [SG] and Roux-en-Y gastric bypass [RYGB]) in cardiac fat pad reduction. A systematic review of the literature was done by searching in Scopus, Web of Science, Cochrane, and PubMed for articles published by September 16, 2022. This review followed the meta-analysis rules based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Nineteen studies met the inclusion criteria out of 128 potentially useful studies, including a total number of 822 patients. The results of subgroup analysis on the type of surgery showed that bariatric surgeries decreased the mean fat pad diameter, but the reduction was greater in SG than in RYGB. Epicardial and pericardial fat type showed a significant decrease of fat pad diameter. The results of subgroup analysis indicated RYGB had a significant reduction in mean fat pad volume. Computed tomography scan and cardiac magnetic resonance imaging showed a significant reduction of the mean cardiac fat pad volume. Epicardial and paracardial fat type showed a significant decrease in volume. The cardiac fat pad diameter and volume were significantly reduced after bariatric surgeries. SG showed greater reduction in fat pad diameter in comparison with RYGB, and RYGB had a significant reduction in mean fat pad volume.

Impact of Bariatric Surgery on Carotid Intima-Media Thickness in Patients with Morbid Obesity: a Prospective Study and Review of the Literature

BACKGROUND AND AIM

One of the main causes of mortality among obese patients is cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is an independent predictor for atherosclerosis and risk of CVD, and has been demonstrated to be related with obesity. This study aimed to evaluate the effect of substantial weight loss after bariatric surgery on CIMT.

METHODS

This prospective study was performed on patients with morbid obesity and standard indications for bariatric surgery in a tertiary referral center in Iran. The mean CIMT values were assessed using B-mode ultrasonography before and 6 months after bariatric surgery.

RESULTS

A total of 32 patients (25 females, 7 males) with a mean age of 38.18 ± 1.18 years were enrolled. Body mass index (BMI) was significantly reduced from 43.66 ± 6.44 to 29.01 ± 2.56 kg/m² during 6 months following surgery (p: 0.001). The mean CIMT values at 6 months after surgery were significantly lower than the baseline (0.53 ± 0.06 vs. 0.50 ± 0.08; p: 0.001). Along with a significant hypertension and metabolic syndrome remission, we observed considerable reduction in FBS (p: 0.019), cholesterol (p: 0.061), triglycerides (p: 0.001), and insulin levels (p: 0.001). Besides, liver stiffness was significantly decreased after surgery (6.15 ± 0.82 vs. 5.26 ± 0.83; p: 0.001). There was no statistically significant correlation between changes in quantitative variables and changes in CIMT.

CONCLUSION

Bariatric surgery results in significant reduction in CIMT, metabolic syndrome factors, and liver stiffness in patients with morbid obesity.

Endocan: a new marker of endothelial function

PURPOSE OF REVIEW

To consider the role of endocan as an inflammatory marker in cardiovascular diseases.

RECENT FINDINGS

Endocan, an endothelial inflammatory marker, is associated with cardiovascular disease.

SUMMARY

Vascular endothelial inflammation plays a key role in the pathogenesis of inflammatory and cardiovascular diseases by influencing thrombogenesis, tumour invasion and secretion of bioactive mediators. We discuss the role of endocan mainly in the context of cardiology.