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European Heart Journal

Year: 2009  |  Volume: 30  |  Issue: 12  |  Page No.: 1516 - 1524

Non-conventional markers of atherosclerosis before and after gastric banding surgery

U Hanusch Enserer, G Zorn, J Wojta, C. W Kopp, R Prager, W Koenig, M Schillinger, M Roden and K. Huber

Abstract

Aims

Obesity and type 2 diabetes are associated with increased cardiovascular risk and elevation of traditional and non-traditional risk markers. As bariatric surgery reduces overweight and improves metabolic derangement, we examined a cluster of established and emerging cardiovascular risk factors, such as soluble CD40 ligand (sCD40L) and lipoprotein-associated phospholipase A2 (Lp-PLA2), which might improve prediction of future cardiovascular events because of their more direct involvement in plaque destabilization.

Methods and results

Obese patients [n = 32, body mass index (BMI) 46.1 ± 5.9 kg/m2] underwent clinical examinations and blood sampling for measurement of glucose and lipid parameters as well as non-traditional cardiovascular risk markers, i.e. high-sensitivity C-reactive protein, plasminogen activator inhibitor-1 (PAI-1), soluble cellular adhesion molecules (CAM), MMP-2, MMP-9, CD40L, and Lp-PLA2 before and after 1 year following laparoscopic adjustable gastric banding (LAGB), respectively. In patients undergoing LAGB, blood pressure (P < 0.0001) and blood glucose (P = 0.02) were significantly lowered by approximately 16% as well as triglyceride levels by approximately 29% (P = 0.002). In addition to a decrease of the inflammatory and pro-thrombotic marker PAI-1 (P = 0.001), CAMs, and MMP-9 (P = 0.004) were reduced, whereas no change was observed for plasma levels of MMP-2, sCD40L, and Lp-PLA2 after LAGB, respectively. Individual changes in (ICAM-1) intercellular adhesion molecule-1 (ICAM-1) were related to changes in insulin (fasting insulin) before and after LAGB (r = 0.36 and r = 0.38; both P = 0.04). E-selectin correlated positively with changes in BMI (r = 0.38; P = 0.04 and r = 0.36; P = 0.05), while Lp-PLA2 concentration was negatively correlated with BMI (r =–0.41; P = 0.02) after 1 year. Changes were comparable in both overweight diabetic and non-diabetic subjects.

Conclusion

LAGB not only induced weight loss but also an improvement in the subclinical pro-inflammatory state. However, concentrations of most of the non-traditional risk factors for plaque instability, i.e. MMP-9, sCD40L, and Lp-PLA2 remained unchanged.

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