Effect of bariatric surgery on microvascular dysfunction associated to metabolic syndrome: a 12-month prospective study.
OBJECTIVE
To prospectively evaluate the effect of weight loss after bariatric surgery on microvascular function in morbidly obese patients with and without metabolic syndrome (MetS).


METHODS
A cohort of morbidly obese patients with and without MetS was studied before surgery and after 12 months of surgery. Healthy lean controls were also examined. Microvascular function was assessed by postocclusive reactive hyperemia (PORH) at forearm skin evaluated by laser Doppler flowmetry (LDF). Cutaneous vascular conductance (CVC) was calculated from laser-Doppler skin blood flow and blood pressure. Regression analysis was performed to assess the contribution of different clinical, metabolic and biochemical parameters to microvascular function.


RESULTS
Before surgery, 62 obese patients, 39 with MetS and 23 without MetS, and 30 lean control subjects were analyzed. The absolute area under the hyperemic curve (AUC(H)) CVC of PORH was significantly decreased in obese patients compared with lean control subjects. One year after surgery, AUC(H) CVC significantly increased in patients free of MetS, including patients that had MetS before surgery. In contrast, AUC(H) CVC did not significantly change in patients in whom MetS persisted after surgery. Stepwise multivariate regression analysis showed that only changes in HDL cholesterol (HDL-C) and oxidized LDL (oxLDL) independently predicted improvement of AUC(H) after surgery. These two variables together accounted for 40.9% of the variability of change in AUC(H) CVC after surgery.


CONCLUSIONS
Bariatric surgery could significantly improve microvascular dysfunction in obese patients, but only in patients free of MetS after surgery. Improvement of microvascular dysfunction is strictly associated to postoperative increase in HDL-C levels and decrease in oxLDL levels.
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain.
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Martín-Rodríguez
Unidad de Ensayos Clínicos, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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Cervera-Barajas
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain.
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Madrazo-Atutxa
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain.
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García-Luna
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain.
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JL
Pereira
Unidad de Bioquímica Clínica, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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J
Castro-Luque
Unidad de Bioquímica Clínica, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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León-Justel
Unit of Innovation in Minimally Invasive Surgery, Unidad de Gestión Clínica de Cirugía, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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Morales-Conde
Unidad de Ensayos Clínicos, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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JR
Castillo
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain.
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Leal-Cerro
Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain.
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Cano
D000328:Adult; D000704:Analysis of Variance; D019540:Area Under Curve; D050110:Bariatric Surgery; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000503:physiopathology*; D017078:Laser-Doppler Flowmetry; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D008833:Microcirculation; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D011446:Prospective Studies; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply*; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D015431:Weight Loss