TOPLINE:

In patients with obesity, sleeve gastrectomy reduces carotid intima-media thickness (CIMT), oxidized low-density lipoprotein (LDL), and plasminogen activator inhibitor-1 (PAI-1) levels at 1 year. Oxidized LDL is a better prediction of elevated CIMT than PAI-1 levels.

METHODOLOGY:

• Obesity is a chronic disease linked to metabolic complications such as type 2 diabetes, dyslipidemia, and nonalcoholic fatty liver disease and increases cardiovascular risk through chronic low-grade inflammation, oxidative stress, and impaired fibrinolysis.
• In this single-center prospective cohort study, researchers evaluated patients with obesity undergoing sleeve gastrectomy to examine associations between CIMT, oxidized LDL, and PAI-1, as well as anthropometric indices, insulin resistance, lipid profiles, and inflammatory markers.
• Inclusion criteria were age greater than 18 years with BMI > 35 or BMI > 30 with at least one obesity-associated disease; exclusion criteria included established atherosclerotic cardiovascular disease, coagulopathies, or current malignancy.
• Assessments were conducted before surgery and at 12 months postoperatively and included CIMT (using high-resolution B-mode ultrasonography), BMI, waist-hip ratio, and fasting serum levels of oxidized LDL, PAI-1, lipids, glucose, insulin resistance, leptin, and high-sensitivity C-reactive protein.

TAKEAWAY:

• Researchers enrolled 93 patients (mean age, 39.6 years; 82.8% female; baseline BMI, 46.8).
• At 12 months, oxidized LDL decreased by 107.5 μg/mL and PAI-1 by 1293.9 pg/mL (P < .001 for both), accompanied by improvements in lipid profile, inflammatory biomarkers, and insulin resistance (P < .001 for all).
• Oxidized LDL and PAI-1 showed a strong bidirectional association, with higher levels of one predicting higher levels of the other (P < .001).
• Oxidized LDL demonstrated acceptable discriminative ability for predicting at least a 1 mm increase in CIMT (area under the curve [AUC], 0.73; sensitivity, 82.1%; specificity, 64.8%), whereas PAI-1 showed limited performance (AUC, 0.64; sensitivity, 48.7%; specificity, 79.6%).
• A greater waist-hip ratio was associated with increased odds of CIMT ≥ 1 mm (P = .023).

IN PRACTICE:

“In patients with obesity undergoing [sleeve gastrectomy], significant improvements in vascular, inflammatory, and fibrinolytic markers were noted over 1 year,” the authors of the study wrote. “Reduced CIMT correlated with lower PAI-1 and oxidized LDL levels, suggesting reversibility of obesity-associated vascular risks.”

SOURCE:

The study was led by Mohamed Hany, Medical Research Institute, Alexandria University, Alexandria, Egypt. It was published online inObesity Surgery.

LIMITATIONS: 

The single-center study had a modest sample size, limiting generalizability. The absence of a nonsurgical control group precluded attributing changes solely to the surgery. Medication exposure during follow-up was not systematically recorded, and residual confounding from time-varying therapies (eg, lipid-lowering, antiplatelet, antihypertensive, and glucose-lowering agents) cannot be excluded.

DISCLOSURES:

The study received open-access funding from the Science, Technology & Innovation Funding Authority in cooperation with the Egyptian Knowledge Bank. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.