The Amelioration of Inflammation and Endothelial Dysfunction, and the Increase in Testosterone After Obesity Surgery Decreases Carotid Intima-Media Thickness in Men

Abstract Introduction: Obesity increases cardiovascular risk in men through several mechanisms. Among them, low-grade chronic inflammation and possibly obesity-associated hypogonadism have been described. We aimed to study the association of cardiovascular risk with changes in inflammatory and endothelial dysfunction markers and testosterone. Methods We included 60 men, 20 submitted to laparoscopic Roux-en-Y gastric bypass (RYGB), 20 to sleeve gastrectomy (SG), and 20 to life-style modification (controls). Several inflammatory markers and total testosterone (TT) were measured at baseline and six months after surgery. Free testosterone (FT) was calculated, and carotid intima-media thickness (cIMT) measured by ultrasonography. Results Compared to controls, cIMT decreased after surgery concomitantly with CRP, PAI-1, sICAM-1, IL-18 (P<0.01) and with an increase in sTWEAK (P=0.027), with no differences between RYGB and SG. The increase in TT and FT after surgery correlated with the changes in cIMT (P=0.010 and P=0.038 respectively), but this association disappeared after multivariate analysis. Linear regression showed that sTWEAK (ß=-0.245, P=0.039), PAI-1 (ß=0.346, P=0.005) and CRP (ß=0.236, P=0.049) were associated with the changes in cIMT (R2=0.267, F=6.664, P=0.001). Conclusion Both RYGB and SG in men induced a similar beneficial response on inflammatory and endothelial dysfunction markers that was associated with a decrease in cIMT.