Abstract
BackgroundBariatric surgery is able to improve glucose and lipid metabolism, and cardiovascular function in morbid obesity. Aim of this study was to compare the long-term effects of malabsorptive (biliary pancreatic diversion, BPD), and restrictive (laparoscopic gastric banding, LAGB) procedures on metabolic and cardiovascular parameters, as well as on metabolic syndrome in morbidly obese patients.Methods170 patients studied between 1989 and 2001 were called back after a mean period of 65 months. 138 patients undergoing BPD (n = 23) or LAGB (n = 78), and control patients (refusing surgery and treated with diet, n = 37) were analysed for body mass index (BMI), blood glucose, cholesterol, and triglycerides, blood pressure, heart rate, and ECG indexes (QTc, Cornell voltage-duration product, and rate-pressure-product).ResultsAfter a mean 65 months period, surgery was more effective than diet on all items under evaluation; diabetes, hypertension, and metabolic syndrome disappeared more in surgery than in control patients, and new cases appeared only in controls. BPD was more effective than LAGB on BMI, on almost all cardiovascular parameters, and on cholesterol, not on triglyceride and blood glucose. Disappearance of diabetes, hypertension, and metabolic syndrome was similar with BPD and with LAGB, and no new cases were observed.ConclusionThese data indicate that BPD, likely due to a greater BMI decrease, is more effective than LAGB in improving cardiovascular parameters, and similar to LAGB on metabolic parameters, in obese patients. The greater effect on cholesterol levels is probably due to the different mechanism of action.
Highlights
Bariatric surgery is able to improve glucose and lipid metabolism, and cardiovascular function in morbid obesity
Laparoscopic gastric banding (LAGB) and biliary pancreatic diversion (BPD) are routinely performed at participating Institutions, following the indications and guidelines of NIH [29]; procedures have been approved by local ethics committees; patients undergo preliminary clinical work-up including psychological and psychiatric evaluation [14]
Patients undergoing surgery between 1989 and 2001 were considered in this study; all patients agreeing to come back to Institutions were considered; they were interviewed about current therapies, and underwent anthropometric evaluation, ECG recording, and heart rate and blood pressure measurement, fasting blood sampling for glucose and lipid determination
Summary
Bariatric surgery is able to improve glucose and lipid metabolism, and cardiovascular function in morbid obesity. Insulin resistance [4], subclinical inflammation [5], sympathetic overactivity [6], and endothelial dysfunction [7], are present and often coexist in the same individual [8]. These abnormalities are risk factors for the development of left ventricular hypertrophy [LVH, [9,10]], which is frequently detected in severe obesity, and is an alleged risk factor for CHF [3,10]. Bariatric surgery has been shown to prevent arterial hypertension [19] and diabetes mellitus [19,20,21]
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