Cardiovascular Biomarkers Improved After Metabolic Surgery for Diabetes

By Will Boggs MD

July 12, 2019

NEW YORK (Reuters Health) - Cardiovascular biomarkers in people with type 2 diabetes improve to a greater extent after metabolic surgery than with medical therapy, according to results from the STAMPEDE trial.

"The ability of bariatric surgery to target several important cardiovascular risk factors simultaneously is quite amazing," said Dr. Deepak L. Bhatt from Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, in Boston.

"Reflecting these widespread salutary effects, in the STAMPEDE biomarker analysis, we saw improvements in markers of dyslipidemia, inflammation, thrombosis, and of course, glycemia. Coupled with large, sustained reductions in body weight, these beneficial effects on biomarkers provide further support for metabolic surgery as a means to reduce cardiovascular risk," he told Reuters Health by email.

Dr. Bhatt's team compared 12 cardiovascular biomarkers after up to five years in 150 patients with type 2 diabetes and a body mass index (BMI) from 27 to 43 kg/m2 who were randomized to intensive medical therapy (IMT) alone or IMT plus Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

Apolipoprotein A-I, high-sensitivity C-reactive protein, and plasminogen activator inhibitor-1 improved significantly more in both surgical groups than in the IMT group, the researchers report in the Journal of the American College of Cardiology, online July 8.

Myeloperoxidase, interleukin-6, leptin, adiponectin, and uric acid improved significantly after RYGB (compared with IMT) and leptin was reduced after RYGB (compared with SG).

Low-density lipoprotein cholesterol and apolipoprotein B levels did not differ significantly among the three groups.

Weight loss at five years' follow-up averaged 23.2 kg after RYGB, 18.6 kg after SG and 5.3 kg with IMT.

"We need to think about metabolic surgery much sooner in people who are obese and have type 2 diabetes mellitus," Dr. Bhatt said. "If anything, the data from STAMPEDE and other studies show that intervening earlier in the course of diabetes is more likely to lead to complete remission of diabetes - an incredible achievement when it occurs."


J Am Coll Cardiol 2019.