title: Morphological Changes in the Carotid Artery Intima after Gastric Bypass for Morbid Obesity.
abstract: Carotid intima-media thickness (C-IMT) can be considered as an early marker of atherosclerosis, thus representing a reliable cardiovascular risk predictor. Bariatric surgery decreases the burden of cardiovascular disease in obese patients through complex mechanisms, of which weight loss is merely the most evident epiphenomenon. The aim of this study is to evaluate C-IMT variations in patients undergoing Roux-en-Y gastric bypass (RYGB) and possible correlations with biometric parameters and cardiovascular risk factors.
  
  
  
  Thirty patients undergoing RYGB for morbid obesity were enrolled for carotid artery B-mode ultrasound evaluation before surgery and at 1-, 3-, 6-, and 12-month follow-up; C-IMT was recorded at three levels (bulb, common, and internal carotid). At each one of the follow-ups, biometric and serohematic parameters were also collected.
  
  
  
  The 22 patients who completed the follow-up and were included in the study showed significant C-IMT reduction at all three levels at 12-month follow-up (p < 0.001). Along with a significant BMI reduction and diabetes/hypertension remission, we found a considerable decrease in total cholesterol (219 vs 164 mg/dl; p < 0.001) and uric acid (5.6 vs 4.5 mg/dl; p < 0.01) and a significant increase in HDL cholesterol (43.9vs59.2 mg/dl; p < 0.001). The data imply that the mean 10-year cardiovascular risk score drops by nearly 50 % (5.7 ± 5.6 vs. 2.9 ± 2.7 %, p < 0.001) according to Framingham cardiovascular risk stratification.
  
  
  
  RYGB is associated with significant decrease in C-IMT at 1 year. Pathophysiologic processes underlying such a variation, probably involving lipid and urate metabolism and their correlation with cardiovascular risk reduction should be confirmed by long-term prospective trials.
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy. fede53@lycos.com.
authors.forename: Federico
authors.identifier: 0000-0001-8236-3224
authors.initials: F
authors.lastname: Marchesi
authors.affiliation: Clinica 'Città di Parma', Dipartimento di Medicina Interna, piazzale Maestri 5, Parma, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Giacosa
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Reggiani
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: De Sario
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tartamella
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Melani
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Mita
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Francesco Giovanni
authors.initials: FG
authors.lastname: Cinieri
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cecchini
authors.affiliation: Azienda provinciale per i servizi sanitari della p.a di Trento, UOPSAL. Viale Verona, 38123, Trento, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ricco'
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Chirurgia Vascolare, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Pierfranco
authors.initials: P
authors.lastname: Salcuni
authors.affiliation: Dipartimento di Scienze Chirurgiche, sezione di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli studi di Parma, Via Gramsci n.14, 43100, Parma, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Roncoroni
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000473:pathology / Q000517:prevention & control; D017536:Carotid Artery, Common / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
keywords: Bariatric surgery; Cardiovascular risk; Carotid intima-media thickness; Obesity