Abstract
Predictive indices like the atherogenic index of plasma (AIP) have been developed to estimate the risk of cardiovascular disease (CVD). Metabolic surgery is the most effective treatment for a rapid improvement of morbid obesity and its comorbidities such as type 2 diabetes (T2D) and CVD. A decreased reoccurrence of CVD after metabolic surgery has been reported by several studies. However, studies utilizing predictive indices for CVD risk in CVD-free morbid-obese patients who undertook laparoscopic sleeve gastrectomy (LSG) are lacking. Here, we use AIP as a tool to evaluate the improvement in CVD risk post-LSG in morbid-obese people who had no history of CVD. Method. We compared baseline, 6- and 12-month post-LSG score of AIP, vascular age, circulating biochemical markers related to CVD in two groups of BMI and age-matched morbid-obese participants with and without T2D. Results. At baseline, people with T2D had significantly higher AIP both, with morbid obesity (0.23 ± 0.06, p < 0.001) and normal weight (0.022 ± 0.05, p < 0.001) compared to their BMI-matched without T2D group. People with morbid obesity had low AIP (−0.083 ± 0.06). Vascular age was significantly higher in people with morbid obesity and T2D (65.8 ± 3.7year, p < 0.0001) compared to morbid obesity (37.9 ± 2.6 year). After one year, AIP was significantly reduced compared to baseline score in people with morbid obesity with/without T2D, respectively (−0.135 ± 0.07, p = 0.003; and −0.36 ± 0.04, p = 0.0002). Conclusion. Our data illuminates AIP as a reliable predictive index for CVD risk in morbid-obese people who had no history of CVD. Moreover, AIP accurately distinguishes between morbid obesity with T2D and morbid obesity and showed a rapid and significant reduction in CVD risk after LSG in people who had no history of CVD. This is a ClinicalTrials.gov registered trial (Reference NCT03038373).
Highlights
Obesity is a global health burden that is associated with a number of abnormalities and comorbidities, most notably insulin resistance, dyslipidemia, hypertension [1], a higher risk of developing type 2 diabetes (T2D), and cardiovascular disease (CVD) [2]
Levels of hs-creactive protein (CRP) were elevated in people with morbid obesity and T2D (1:3 ± 0:1 mM, n = 17) and without T2D (1:1 ± 0:1 mM, n = 23), reflecting a state of inflammation that suggests a possible moderate CVD risk in participants with morbid obesity, both with and without T2D
Lipid profile of people with morbid obesity and T2D was characterized by increased levels of TG, and very-low-density lipoprotein (VLDL; 0:7 ± 0:08 mM, n = 17) and reduced highdensity lipoprotein (HDL) (0:9 ± 0:04 mM, n = 17) that was significantly different from people with morbid obesity (Table 1)
Summary
Obesity is a global health burden that is associated with a number of abnormalities and comorbidities, most notably insulin resistance, dyslipidemia, hypertension [1], a higher risk of developing type 2 diabetes (T2D), and cardiovascular disease (CVD) [2]. The past years involved a rise in metabolic surgeries that emerged as a rapid and effective treatment option for people with severe obesity. These surgeries improved weight and resolved obesity-related comorbidities. Elevated levels of a proinflammatory molecule, such as creactive protein (CRP), contribute to a rise in oxidative stress and lipid peroxidation. Oxidative stress is one of the factors contributing to vascular dysfunction, which is implicated in the pathogenesis of atherosclerosis, T2D, and hypercholesterolemia [6, 7]. Dyslipidemia is another risk factor for premature atherosclerosis and an increased CVD risk. To assess patients’ risk of developing CVD, various novel biomarkers have been identified [11]. For which identifying novel biomarkers and developing new indices that are accurate, reliable and easy to quantify is required
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