Bariatric surgery as a model to explore the basis and consequences of the Reaven hypothesis: Small, dense low-density lipoprotein and interleukin-6. (March 2019)

• Record Type: Journal Article
• Authors: Adam, Safwaan; Liu, Yifen; Siahmansur, Tarza; Ho, Jan H; Dhage, Shaishav S; Yadav, Rahul; New, John P; Donn, Rachelle; Ammori, Basil J; Syed, Akheel A; Malik, Rayaz A; Soran, Handrean; Durrington, Paul N
• Is Part Of: Diabetes & vascular disease research. Volume 16:Number 2(2019:Mar.)
• Page Start: 144
• Page End: 152
• Publication Date: 2019-03
• Subjects: Insulin resistance -- Reaven's hypothesis -- bariatric surgery -- obesity -- metabolic syndrome -- triglycerides; Diabetic angiopathies -- Periodicals; 616.462005
• DOI: 10.1177/1479164119826479
• Languages: English
• ISSNs: 1479-1641

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/m 2, 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.