TY - JOUR
T1 - Effect of Bariatric Surgery on Flow-Mediated Vasodilation as a Measure of Endothelial Function
T2 - A Systematic Review and Meta-Analysis
AU - Jamialahmadi, Tannaz
AU - Alidadi, Mona
AU - Atkin, Stephen L.
AU - Kroh, Matthew
AU - Almahmeed, Wael
AU - Moallem, Seyed Adel
AU - Al-Rasadi, Khalid
AU - Rodriguez, John H.
AU - Santos, Raul D.
AU - Ruscica, Massimiliano
AU - Sahebkar, Amirhossein
N1 - Publisher Copyright:
© 2022 by the authors.
PY - 2022/7/13
Y1 - 2022/7/13
N2 - OBJECTIVES: Flow mediated vasodilation (FMD) is a marker of endothelial function and its decline is related to increased cardiovascular risk. This systematic review and meta-analysis evaluated the impact of bariatric surgery on FMD.MATERIALS AND METHODS: A systematic literature search in PubMed, Scopus, Embase, and Web of Science was performed to 1 May 2021. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V2 software. All types of bariatric surgery were considered, with the inclusion that FMD had to have been tested before and after the surgical procedure. Meta-analysis was carried out using a random-effects model and the generic inverse variance approach. The leave-one-out approach was used for sensitivity analysis. To assess metabolic parameter confounders, a weighted random-effects meta-regression was used.RESULTS: A meta-analysis and a systematic review of 23 studies (n = 891 individuals) demonstrated improvement in FMD following bariatric surgery (weighted mean difference (WMD): 5.867, 95% CI: 4.481, 7.252,
p < 0.001; I
2: 96.70). Iteratively removing each item in the meta-analysis did not result in a significant alteration in the pooled estimate of effect size. There was an improvement in FMD for up to 6 months following bariatric surgery in a meta-analysis from 7 trials that included 356 subjects (WMD: 5.248, 95% CI: 2.361, 8.135,
p < 0.001; I
2: 98.18). The meta-analysis from 9 trials (n = 414 subjects) showed an improvement in FMD 6 to 12 months after bariatric surgery (WMD: 5.451, 95% CI: 3.316, 7.587,
p < 0.001; I
2: 94.18). The meta-analysis from 10 trials (n = 414 subjects) demonstrated an improvement in FMD 12 months after bariatric surgery (WMD: 2.401, 95% CI: 0.944, 3.859,
p = 0.001; I
2: 88.35). Random-effects meta-regression did not show any association between the alteration in FMD and percent body mass index (BMI) change (slope: 0.0258; 95% CI: -0.323, 0.375;
p = 0.884), or changes in blood pressure; however, there was an association between the changes in FMD and the duration of follow-up (slope: -0.106; 95% CI: -0.205, -0.008;
p = 0.033) with greater changes in FMD after 12 months.
CONCLUSIONS: Bariatric surgery significantly improved FMD that increased with time, and the resultant improvement in endothelial function was independent of weight loss or a reduction in blood pressure.
AB - OBJECTIVES: Flow mediated vasodilation (FMD) is a marker of endothelial function and its decline is related to increased cardiovascular risk. This systematic review and meta-analysis evaluated the impact of bariatric surgery on FMD.MATERIALS AND METHODS: A systematic literature search in PubMed, Scopus, Embase, and Web of Science was performed to 1 May 2021. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V2 software. All types of bariatric surgery were considered, with the inclusion that FMD had to have been tested before and after the surgical procedure. Meta-analysis was carried out using a random-effects model and the generic inverse variance approach. The leave-one-out approach was used for sensitivity analysis. To assess metabolic parameter confounders, a weighted random-effects meta-regression was used.RESULTS: A meta-analysis and a systematic review of 23 studies (n = 891 individuals) demonstrated improvement in FMD following bariatric surgery (weighted mean difference (WMD): 5.867, 95% CI: 4.481, 7.252,
p < 0.001; I
2: 96.70). Iteratively removing each item in the meta-analysis did not result in a significant alteration in the pooled estimate of effect size. There was an improvement in FMD for up to 6 months following bariatric surgery in a meta-analysis from 7 trials that included 356 subjects (WMD: 5.248, 95% CI: 2.361, 8.135,
p < 0.001; I
2: 98.18). The meta-analysis from 9 trials (n = 414 subjects) showed an improvement in FMD 6 to 12 months after bariatric surgery (WMD: 5.451, 95% CI: 3.316, 7.587,
p < 0.001; I
2: 94.18). The meta-analysis from 10 trials (n = 414 subjects) demonstrated an improvement in FMD 12 months after bariatric surgery (WMD: 2.401, 95% CI: 0.944, 3.859,
p = 0.001; I
2: 88.35). Random-effects meta-regression did not show any association between the alteration in FMD and percent body mass index (BMI) change (slope: 0.0258; 95% CI: -0.323, 0.375;
p = 0.884), or changes in blood pressure; however, there was an association between the changes in FMD and the duration of follow-up (slope: -0.106; 95% CI: -0.205, -0.008;
p = 0.033) with greater changes in FMD after 12 months.
CONCLUSIONS: Bariatric surgery significantly improved FMD that increased with time, and the resultant improvement in endothelial function was independent of weight loss or a reduction in blood pressure.
KW - bariatric surgery
KW - body mass index
KW - endothelial function
KW - flow-mediated vasodilation
KW - meta-analysis
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UR - https://www.mendeley.com/catalogue/64083528-6df7-3203-b85f-e5d4cc186b7a/
U2 - 10.3390/jcm11144054
DO - 10.3390/jcm11144054
M3 - Review article
C2 - 35887817
AN - SCOPUS:85136439185
SN - 2077-0383
VL - 11
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 14
M1 - 4054
ER -