The Role of Sleeve Gastrectomy in Reducing Cardiovascular Risk.
Obesity is an independent cardiovascular risk factor and a catalyst of other cardiovascular risk factors, such as hypertension, dyslipidemia, type 2 diabetes mellitus (DM2) and metabolic syndrome.



We analyzed cardiovascular risk in obese patients before and after sleeve gastrectomy (SG). To this end, we studied changes in body mass index (BMI), blood chemistry parameters that characterize the risk of atherosclerosis and instrumental parameters (objective markers of this risk), namely intima-media thickness (IMT) and flow-mediated dilation (FMD), the latter reflecting endothelial function. We also considered purely cardiac parameters-mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE)-which describe cardiac risk more specifically than the ejection fraction. Alteration of one or more of these parameters determines an increase in cardiovascular morbidity and mortality.



The results showed that weight loss, in patients undergoing SG, is accompanied by a reduced BMI and a marked improvement in blood chemistry, confirming what has already been shown in many other studies, but the most interesting finding was the effect of SG on the instrumental markers of atherosclerosis. In particular, carotid IMT was significantly reduced (p < 0.001) and FMD significantly improved. MAPSE and TAPSE also improved significantly at both follow-up assessments (p < 0.001).



This study suggests that SG should be considered from a broader perspective, i.e. as a weight loss treatment that also improves obesity-related morbidity and mortality, benefitting both the patient and, in an economic sense, the society as a whole.
Surgical Sciences Department, "Sapienza" University of Rome, Rome, Italy.
Luciana
L
Tromba
Surgical Sciences Department, "Sapienza" University of Rome, Rome, Italy. francesco.tartaglia@uniroma1.it.
Francesco
F
Tartaglia
Surgical Sciences Department, "Sapienza" University of Rome, Rome, Italy.
Sabino
S
Carbotta
Surgical Sciences Department, "Sapienza" University of Rome, Rome, Italy.
Nadia
N
Sforza
Surgical Sciences Department, "Sapienza" University of Rome, Rome, Italy.
Fabio
F
Pelle
Gynecological, Obstetric Sciences Department and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
Vanessa
V
Colagiovanni
Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy.
Giovanni
G
Carbotta
CNR, IBB, Rome, Italy.
Stefania
S
Cavaiola
Surgical Sciences Department, "Sapienza" University of Rome, Rome, Italy.
Giovanni
G
Casella
D000328:Adult; D050197:Atherosclerosis / Q000150:complications; D050110:Bariatric Surgery; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D059168:Carotid Intima-Media Thickness; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D009767:Obesity, Morbid / Q000601:surgery; D012307:Risk Factors; D015431:Weight Loss; D055815:Young Adult
Bariatric surgery; Cardiovascular risk; Color Doppler echocardiography; Obesity; Sleeve gastrectomy