Decrease Of Serum Inflammatory Markers After Laparoscopic Roux-en-y Gastric Bypass And Risk Of Cardiovascular Disease
*Isolina Rossi, Philip Omotosho, *Jennifer Poirier, Alfonso Torquati
Rush University, Chicago, IL
Objective: Obesity and type 2 diabetes mellitus (T2DM) are both associated with elevated levels of serum inflammatory markers. The chronic state of inflammation is known to contribute to increased risk of cardiovascular disease (CVD) in these populations. The laparoscopic Roux-en-Y gastric bypass (LRYGB) has repeatedly been associated with a high rate of diabetes remission.
We hypothesized that, in an obese diabetic population, LRYGB would lead to reduced inflammatory biomarker levels and decreased CVD risk when compared to a matched control medical group. The hypothesis was tested by determining the relationship between circulating cytokines and CVD risk factors. Methods: A single-institution prospective cohort study of 61 morbidly obese (BMI > 35 kg/m2) patients with T2DM. Thirty underwent LRYGB surgery and 31 underwent standard medical therapy with diabetes support and education (DSE). Collected data included pre- and post- operative inflammatory biomarkers and clinical parameters. To determine whether there were relationships between predictive variables and outcome variables, nested multiple regressions were created and compared with likelihood ratio tests.
Results: At baseline, the groups were matched for age, gender, weight, systolic blood pressure, oral anti-diabetic medications, and insulin therapy. Throughout the study, all subjects received the usual medical care and management of T2DM and CVD factors. The goal for glycemic control was to maintain an HbA1c of 7%. The longitudinal changes observed during the study are summarized in Table 1. When sex and age were controlled for in the LRYGB group, a statistically significant relationship remained between percent change in SBP and percent change in IL6 (p = 0.03). Similarly, when sex and age were controlled for in the LRYGB group, a statistically significant relationship remained between percent excess weight loss (EWL) and change in IL6 (p = 0.001).
Conclusion: A multivariable regression analysis of our data suggests that a significant relationship exists between the change of inflammatory cytokine IL-6 and the reduction in systolic blood pressure in morbidly obese diabetics who undergo LRYGB.
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