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Short- and Long-Term Effects of Bariatric Surgery on Vascular Phenotype

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Abstract

Background

Retinal microvascular diameters and large artery stiffness are valid biomarkers of cardiovascular risk. This study assessed short- and long-term micro- and macrovascular improvements after bariatric surgery (BS).

Methods

Sixteen patients (44 ± 12 years) underwent BS in this observational study. Two weeks before as well as 6 weeks and 4 years after surgery, retinal vessel analysis and assessment of brachial-ankle pulse wave velocity (baPWV), cardio-ankle vascular index (CAVI), and anthropometry were performed. Three patients were lost to follow-up.

Results

Six weeks after BS, retinal arteriolar diameters (CRAE) were wider (180.1 μm vs. 188.1 μm; p = 0.001), and the arteriolar-to-venular diameter ratio (AVR) was higher (0.82 vs. 0.86; p < 0.001) compared to baseline levels. During the 4 years of follow-up, the retinal changes sustained but further improvements did not occur. Both indices of large artery stiffness, baPWV and CAVI, remained unchanged 6 weeks and 4 years after surgery.

Conclusions

Retinal microvascular phenotype improved 6 weeks after BS. The improvements in microvascular health were maintained during 4 years of follow-up but, despite significant further reductions in body mass index, did not improve further long-term. baPWV and CAVI were unaffected after surgery indicating that BS primarily affects microvascular phenotype rather than large artery stiffness. Retinal vessel imaging seems to be a feasible diagnostic tool to monitor microvascular health after BS. Normalization of BMI and blood pressure may be necessary to achieve long-term improvement of large artery phenotype after BS.

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Abbreviations

AVR:

retinal arteriolar-to-venular diameter ratio

baPWV:

brachial-ankle pulse wave velocity (m/s)

BMI:

body mass index (kg/m2)

BS:

bariatric surgery

CAVI:

cardio-ankle vascular index

CRAE:

central retinal arteriolar equivalent (μm)

CRVE:

central retinal venular equivalent (μm)

MAP:

mean arterial pressure (mmHg)

PWV:

pulse wave velocity (m/s)

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Acknowledgments

We would like to thank all study participants and supporting staff wholeheartedly, which facilitated the study.

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Correspondence to Henner Hanssen.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Streese, L., Königstein, K., Goricki, L. et al. Short- and Long-Term Effects of Bariatric Surgery on Vascular Phenotype. OBES SURG 29, 1301–1308 (2019). https://doi.org/10.1007/s11695-018-03679-2

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