Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
INSERM U970 Team 7, Paris Cardiovascular Research Centre - PARCC, Universitè Paris-Cité, Paris, France.
Eur J Clin Invest. 2024 Sep;54(9):e14256. doi: 10.1111/eci.14256. Epub 2024 May 22.
Cardiovascular trials have revealed the positive impact of GLP-1 receptor agonists (GLP-1 RAs) on cardiovascular outcomes in type 2 diabetes (T2D). However, the specific effects of endogenous GLP-1 on arterial stiffness and renal function remain understudied. This study aimed to explore the influence of endogenous GLP-1 response post-bariatric surgery on arterial stiffness and renal haemodynamic.
Thirty individuals with morbid obesity and without T2D, scheduled for Roux-en-Y Gastric Bypass (RYGB), were included. Clinical parameters, 3-hour oral glucose tolerance test (OGTT) with serial sampling for glycaemia, GLP-1 and insulin, carotid-femoral pulse wave velocity (cf-PWV), carotid distensibility coefficient (carotid-DC) and renal resistive index (RRI) measurements were conducted pre-surgery and 1-year post-surgery. Participants were categorized into high-response and low-response groups based on their post-surgery increase in GLP-1 (median increase of 104% and 1%, respectively, pre- vs. post-surgery).
Post-surgery, high-response group demonstrated a greater reduction in cf-PWV (p = .033) and a greater increase (p = .043) in carotid DC compared to low-response group. These enhancements were observed independently of weight loss or blood pressure changes. High-response group exhibited a reduction in RRI (p = .034), although this association was influenced by improvement in pulse pressure. Finally, a multivariate stepwise regression analysis indicated that the percentage increase of GLP1, Δ-GLP1%, was the best predictor of percentage decrease in cf-PWV (p = .014).
Elevated endogenous GLP-1 response following RYGB was associated with improved arterial stiffness and renal resistances, suggesting potential cardio-renal benefits. The findings underscore the potential role of endogenous GLP-1 in influencing vascular and renal haemodynamics independent of traditional weight loss.
心血管试验已经揭示了 GLP-1 受体激动剂（GLP-1RAs）对 2 型糖尿病（T2D）患者心血管结局的积极影响。然而，内源性 GLP-1 对动脉僵硬度和肾功能的具体影响仍研究不足。本研究旨在探讨减重手术后内源性 GLP-1 反应对动脉僵硬度和肾脏血流动力学的影响。
纳入 30 名患有肥胖症但无 T2D 的患者，计划接受 Roux-en-Y 胃旁路术（RYGB）。术前和术后 1 年进行临床参数、3 小时口服葡萄糖耐量试验（OGTT），连续采样测量血糖、GLP-1 和胰岛素、颈动脉-股动脉脉搏波速度（cf-PWV）、颈动脉扩张系数（carotid-DC）和肾阻力指数（RRI）。根据术后 GLP-1 的增加情况，将患者分为高反应组和低反应组（术后分别增加 104%和 1%，术前 vs. 术后）。
术后，高反应组 cf-PWV 降低更为显著（p=0.033），颈动脉 DC 增加更为显著（p=0.043），与低反应组相比。这些改善独立于体重减轻或血压变化。高反应组的 RRI 降低（p=0.034），尽管这一关联受到脉压改善的影响。最后，多元逐步回归分析表明，GLP1 的百分比增加，即Δ-GLP1%，是 cf-PWV 百分比降低的最佳预测因子（p=0.014）。
RYGB 后内源性 GLP-1 反应的增加与动脉僵硬度和肾脏阻力的改善相关，提示可能具有心脏-肾脏获益。这些发现强调了内源性 GLP-1 独立于传统体重减轻对血管和肾脏血流动力学的潜在影响。
