Obesity surgery has shown to decrease the carotid intima-media thickness (IMT), but studies that compare different surgical techniques are scarce, especially in men.
To evaluate the changes in IMT in men after laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) and its association with circulating testosterone.
We studied 40 men with severe obesity, of whom 20 were submitted to laparoscopic RYGB and 20 to SG. Twenty control men matched for age and degree of obesity were also included. Both patients and controls were evaluated at baseline and 6 months after surgery or conventional treatment with diet and exercise, respectively.
The mean carotid IMT decreased after surgery irrespective of the surgical technique whereas no changes were observed in the control men submitted to conventional therapy (Wilks’ λ = 0.745, P < 0.001 for the interaction, P < 0.001 for RYGB vs. controls, P = 0.001 for SG vs. controls, P = 0.999 for RYGB vs. SG). The decrease in the carotid IMT correlated with the increase in total testosterone (r = 0.428, P = 0.010) and lost BMI (r = 0.486, P < 0.001). Multivariate linear regression retained only the decrease in BMI (β = 0.378, P = 0.003) after adjustment (R2 = 0.245, F = 9.229, P = 0.001).
Both RYGB and SG decrease carotid IMT in men with obesity compared with conventional treatment with diet and exercise.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.
Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–2219.
Poirier P, Giles TD, Bray GA, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113(6):898–918.
Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.
Balsa JA, Botella-Carretero JI, Gomez-Martin JM, et al. Copper and zinc serum levels after derivative bariatric surgery: differences between Roux-en-Y gastric bypass and biliopancreatic diversion. Obes Surg. 2011;21(6):744–50.
Balsa JA, Botella-Carretero JI, Peromingo R, et al. Chronic increase of bone turnover markers after biliopancreatic diversion is related to secondary hyperparathyroidism and weight loss. Relation with bone mineral density. Obes Surg. 2010;20(4):468–73.
Chapin BL, LeMar Jr HJ, Knodel DH, et al. Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg. 1996;131(10):1048–52. discussion 1053
Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89(3):1061–5.
Balsa JA, Botella-Carretero JI, Peromingo R, et al. Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion. J Endocrinol Investig. 2008;31(10):845–50.
Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes. 2008;32(Suppl 7):S93–7.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.
Bots ML, Hofman A, Grobbee DE. Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study Arterioscler Thromb. 1994;14(12):1885–91.
Bots ML, Witteman JC, Grobbee DE. Carotid intima-media wall thickness in elderly women with and without atherosclerosis of the abdominal aorta. Atherosclerosis. 1993;102(1):99–105.
Bots ML, Hoes AW, Koudstaal PJ, et al. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997;96(5):1432–7.
Vlachopoulos C, Xaplanteris P, Aboyans V, et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis. 2015;241(2):507–32.
Lupoli R, Di Minno MN, Guidone C, et al. Effects of bariatric surgery on markers of subclinical atherosclerosis and endothelial function: a meta-analysis of literature studies. Int J Obes. 2016;40(3):395–402.
Tschoner A, Sturm W, Gelsinger C, et al. Long-term effects of weight loss after bariatric surgery on functional and structural markers of atherosclerosis. Obesity (Silver Spring). 2013;21(10):1960–5.
Garcia G, Bunout D, Mella J, et al. Bariatric surgery decreases carotid intima-media thickness in obese subjects. Nutr Hosp. 2013;28(4):1102–8.
Vitale C, Mendelsohn ME, Rosano GM. Gender differences in the cardiovascular effect of sex hormones. Nat Rev Cardiol. 2009;6(8):532–42.
Gomez-Martin JM, Aracil E, Galindo J, et al. Improvement in cardiovascular risk in women after bariatric surgery as measured by carotid intima-media thickness: comparison of sleeve gastrectomy versus gastric bypass. Surg Obes Relat Dis. 2017;13(5):848–54.
Calderon B, Galdon A, Calanas A, et al. Effects of bariatric surgery on male obesity-associated secondary hypogonadism: comparison of laparoscopic gastric bypass with restrictive procedures. Obes Surg. 2014;24:1686–92.
Calderon B, Gomez-Martin JM, Vega-Pinero B, et al. Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight. Andrology. 2016;4(1):62–7.
Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5.
Shah B, Sucher K, Hollenbeck CB. Comparison of ideal body weight equations and published height-weight tables with body mass index tables for healthy adults in the United States. Nutr Clin Pract. 2006;21(3):312–9.
Montero PN, Stefanidis D, Norton HJ, et al. Reported excess weight loss after bariatric surgery could vary significantly depending on calculation method: a plea for standardization. Surg Obes Relat Dis. 2011;7(4):531–4.
Luque-Ramirez M, Mendieta-Azcona C, del Rey Sanchez JM, et al. Effects of an antiandrogenic oral contraceptive pill compared with metformin on blood coagulation tests and endothelial function in women with the polycystic ovary syndrome: influence of obesity and smoking. Eur J Endocrinol. 2009;160(3):469–80.
Luque-Ramirez M, Mendieta-Azcona C, Alvarez-Blasco F, et al. Androgen excess is associated with the increased carotid intima-media thickness observed in young women with polycystic ovary syndrome. Hum Reprod. 2007;22(12):3197–203.
Lorenz MW, Polak JF, Kavousi M, et al. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet. 2012;379(9831):2053–62.
Karason K, Wikstrand J, Sjostrom L, et al. Weight loss and progression of early atherosclerosis in the carotid artery: a four-year controlled study of obese subjects. Int J Obes Relat Metab Disord. 1999;23(9):948–56.
Sturm W, Tschoner A, Engl J, et al. Effect of bariatric surgery on both functional and structural measures of premature atherosclerosis. Eur Heart J. 2009;30(16):2038–43.
Sarmento PL, Plavnik FL, Zanella MT, et al. Association of carotid intima-media thickness and cardiovascular risk factors in women pre- and post-bariatric surgery. Obes Surg. 2009;19(3):339–44.
Lundby-Christensen L, Tarnow L, Hansen DL, et al. Carotid intima-media thickness is reduced 12 months after gastric bypass surgery in obese patients with type 2 diabetes or impaired glucose tolerance. J Diabetes Complicat. 2014;28(4):517–22.
Habib P, Scrocco JD, Terek M, et al. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol. 2009;104(9):1251–5.
Saleh MH, Bertolami MC, Assef JE, et al. Improvement of atherosclerotic markers in non-diabetic patients after bariatric surgery. Obes Surg. 2012;22(11):1701–7.
Marchesi F, Giacosa R, Reggiani V, et al. Morphological changes in the carotid artery intima after gastric bypass for morbid obesity. Obes Surg. 2016.
Altin C, Erol V, Aydin E, et al. Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: a prospective study. Nutr Metab Cardiovasc Dis. 2018;28(5):501–9.
Leeman M, van Mil SR, Al-Ghanam I, et al. Structural and functional vascular improvement 1 year after bariatric surgery: a prospective cohort study. Surg Obes Relat Dis. 2019; in press
Jonker FHW, van Houten VAA, Wijngaarden LH, et al. Age-related effects of bariatric surgery on early atherosclerosis and cardiovascular risk reduction. Obes Surg. 2018;28(4):1040–6.
Lambert G, Lima MMO, Felici AC, et al. Early regression of carotid intima-media thickness after bariatric surgery and its relation to serum leptin reduction. Obes Surg. 2018;28(1):226–33.
Crouse 3rd JR, Byington RP, Bond MG, et al. Pravastatin, lipids, and atherosclerosis in the carotid arteries (PLAC-II). Am J Cardiol. 1995;75(7):455–9.
Stumpe KO, Agabiti-Rosei E, Zielinski T, et al. Carotid intima-media thickness and plaque volume changes following 2-year angiotensin II-receptor blockade. The Multicentre Olmesartan atherosclerosis Regression Evaluation (MORE) study. Ther Adv Cardiovasc Dis. 2007;1(2):97–106.
Huang R, Mills K, Romero J, et al. Comparative effects of lipid lowering, hypoglycemic, antihypertensive and antiplatelet medications on carotid artery intima-media thickness progression: a network meta-analysis. Cardiovasc Diabetol. 2019;18(1):14.
van Mil SR, Biter LU, van de Geijn GJM, et al. The effect of sex and menopause on carotid intima-media thickness and pulse wave velocity in morbid obesity. Eur J Clin Investig. 2019;49(7):e13118.
Khazai B, Golden SH, Colangelo LA, et al. Association of endogenous testosterone with subclinical atherosclerosis in men: the multi-ethnic study of atherosclerosis. Clin Endocrinol. 2016;84(5):700–7.
Kische H, Gross S, Wallaschofski H, et al. Serum androgen concentrations and subclinical measures of cardiovascular disease in men and women. Atherosclerosis. 2016;247:193–200.
Srinath R, Hill Golden S, Carson KA, et al. Endogenous testosterone and its relationship to preclinical and clinical measures of cardiovascular disease in the atherosclerosis risk in communities study. J Clin Endocrinol Metab. 2015;100(4):1602–8.
Chan YX, Knuiman MW, Hung J, et al. Testosterone, dihydrotestosterone and estradiol are differentially associated with carotid intima-media thickness and the presence of carotid plaque in men with and without coronary artery disease. Endocr J. 2015;62(9):777–86.
Farias JM, Tinetti M, Khoury M, et al. Low testosterone concentration and atherosclerotic disease markers in male patients with type 2 diabetes. J Clin Endocrinol Metab. 2014;99(12):4698–703.
Rovella V, Anemona L, Cardellini M, et al. The role of obesity in carotid plaque instability: interaction with age, gender, and cardiovascular risk factors. Cardiovasc Diabetol. 2018;17(1):46.
Escobar-Morreale HF, Santacruz E, Luque-Ramirez M, Botella Carretero JI. Prevalence of ‘obesity-associated gonadal dysfunction’ in severely obese men and women and its resolution after bariatric surgery: a systematic review and meta-analysis. Hum Reprod Update.23(4):390–408.
We thank the nurse staff of the Department of Endocrinology and Nutrition for their help with the anthropometric and blood sampling of the patients.
This study was supported by grant AES/ISCIII - PI18/00132. CIBERobn is also an initiative of Instituto de Salud Carlos III.
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all the participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Cobeta, P., Osorio, A., Cuadrado-Ayuso, M. et al. Sleeve Gastrectomy and Gastric Bypass Decrease the Carotid Intima-Media Thickness in Obese Men: Association with Weight Loss, Cardiovascular Risk Factors, and Circulating Testosterone. OBES SURG (2020). https://doi.org/10.1007/s11695-020-04405-7
- Carotid intima-media thickness
- Gastric bypass
- Obesity surgery
- Sleeve gastrectomy
- Male hypogonadism