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Diab Vasc Dis Res. 2019 Mar;16(2):144-152. doi: 10.1177/1479164119826479.

Bariatric surgery as a model to explore the basis and consequences of the Reaven hypothesis: Small, dense low-density lipoprotein and interleukin-6.

Author information

1
1 Cardiovascular Research Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
2
2 Cardiovascular Trials Unit, Manchester University NHS Foundation Trust, Manchester, UK.
3
3 Department of Diabetes and Endocrinology, Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK.
4
4 Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
5
5 Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK.
6
6 Weill-Cornell Medicine-Qatar, Doha, Qatar.

Abstract

BACKGROUND:

Reaven originally described the clustering of insulin resistance/hyperinsulinaemia, obesity (particularly visceral), altered cytokine levels, glucose intolerance, hypertriglyceridaemia and low high-density lipoprotein cholesterol. Subsequently, a potentially highly atherogenic small, dense low-density lipoprotein was also reported. We have studied the effect of bariatric surgery on this and other risk factors for atherosclerosis.

METHODS:

Forty patients (20 with type 2 diabetes mellitus) undergoing bariatric surgery were studied before and 1 year after bariatric surgery.

RESULTS:

Twelve months after bariatric surgery, median body mass index had decreased from 49.5 to 36.5 kg/m2, fasting insulin from 21.3 to 7.8 mU/L and insulin resistance (homeostatic model assessment of insulin resistance) from 5.9 to 1.8 (all p < 0.001). Thirteen out of 20 patients had remission from type 2 diabetes mellitus. Highly sensitive C-reactive protein, interleukin-6, fasting triglycerides ( p < 0.001) and small, dense low-density lipoprotein ( p < 0.001) decreased, while high-density lipoprotein cholesterol increased ( p < 0.001) significantly, irrespective of having type 2 diabetes mellitus and/or being treated with statin therapy before surgery.

CONCLUSION:

The association between marked weight loss and change in insulin resistance and hyperinsulinaemia with the change in small, dense low-density lipoprotein and interleukin-6 warrants further investigation. Bariatric surgery provides a model for investigating the mechanisms linking insulin resistance/hyperinsulinaemia to atherosclerosis.

KEYWORDS:

Insulin resistance; Reaven’s hypothesis; bariatric surgery; metabolic syndrome; obesity; triglycerides

PMID:
31014098
DOI:
10.1177/1479164119826479
[Indexed for MEDLINE]

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