Effect of bariatric surgery on cardiac structure and function in obese patients: Role of the renin‐angiotensin system

Abstract Background Obesity is recognized as a classic risk factor for atherosclerosis and subsequent cardiovascular disease (CVD). Weight loss after bariatric surgery has been associated with reduced CV mortality and total mortality in obese patients. Our aim was to study the impact of bariatric surgery on CV risk profile, cardiac structure, and function postoperatively. Results This prospective longitudinal study included 100 morbidly obese patients at final analysis. All patients were subjected to full clinical, laboratory, and echocardiographic examination at baseline and 6 months after bariatric surgery. The mean age of study population was 37.2 ± 10.49 with BMI of 47 ± 6.82. Females represented 84%. Sleeve gastrectomy and Roux-en-Y gastric bypass were performed in 79% and 21%, respectively. Surgery-related mortality and morbidity were 0.94% and 4.7%, respectively. After 6 months, there were significant decreases in BMI, heart rate, SBP, DBP, and Framingham risk score (P < 0.0001). The prevalence of risk factors decreased as follows: hypertension 24% vs. 12%, P = 0.0005; DM 21% vs. 11%, P = 0.002; dyslipidemia 32% vs. 7%, P < 0.0001; and metabolic syndrome 54% vs. 26%, P < 0.0001. Highly significant (P < 0.0001) decrease in fasting PG and 2 h PP-PG, HbA1c, ASL, ALT, fasting total cholesterol, LDL, TG, and increase in HDL were observed after bariatric surgery. There were significant shortening in QTc interval (P = 0.009), decrease in LV dimensions and LV mass index (P < 0.0001), and increase in LV EF% (P = 0.0003). BMI at follow-up showed significant positive correlation with age, Framingham risk score, and preoperative BMI (r = 0.289, P = 0.0036; r = 0.37, P = 0.0054; and r = 0.31, P = 0.0081, respectively). Conclusion In addition to enabling patients to achieve a substantial weight loss, bariatric surgery provides a myriad of health benefits. Weight reduction was associated with a favorable improvement in cardiovascular risk profile, cardiac structure, and function.

Download Full-text

Neurohormonal regulation of renal function during development

AJP Renal Physiology ◽

10.1152/ajprenal.1988.254.6.f771 ◽

1988 ◽

Vol 254 (6) ◽

pp. F771-F779 ◽

Cited By ~ 4

Author(s):

J. E. Robillard ◽

K. T. Nakamura

Keyword(s):

Renin Angiotensin System ◽

Renal Hemodynamics ◽

Renal Physiology ◽

Fetal Life ◽

Renal Nerve ◽

Angiotensin System ◽

Postnatal Maturation ◽

Renin Angiotensin ◽

And Function

This review summarizes current understanding of fetal renal physiology and considers the role of the neuroadrenergic system and renin-angiotensin system in controlling renal hemodynamics and function during development. Recent evidence suggests that renal innervation appears early during fetal life but is not an important modulator of renal hemodynamics and function during resting conditions in immature animals. It has also been observed that the renal hemodynamic response to renal nerve stimulation (RNS) is less in fetal and newborn animals than in adults. But contrary to previous findings in adult animals, RNS during alpha-adrenoceptor antagonism produces renal vasodilation in fetal and newborn sheep, but not in adult ewes. The role of the renin-angiotensin system (RAS) in modulating renal hemodynamics and function during prenatal and postnatal maturation is discussed. It is suggested that the RAS plays an important role in regulating blood pressure early during fetal life, whereas its influence on renal hemodynamics and function appears later during development.

Download Full-text