Carotid Intima-media Thickness is Lower after Sleeve Gastrectomy, with Concurrent Changes in Oxidized LDL and PAI-1

Obesity is a chronic condition characterized by low-grade systemic inflammation, oxidative stress, and impaired fibrinolysis, all of which contribute to elevated cardiovascular risk. This study aimed to investigate the association between carotid intima-media thickness (CIMT), oxidized Low-Density Lipoprotein (ox-LDL), plasminogen activator inhibitor-1 (PAI-1), and inflammatory biomarkers in patients with obesity undergoing sleeve gastrectomy (SG), a widely performed metabolic and bariatric surgery (MBS) procedure.

This prospective study included 93 patients with obesity who underwent SG. CIMT, body mass index (BMI), and waist-hip ratio were measured preoperatively and one year postoperatively. Concurrently, serum levels of ox-LDL, PAI-1, lipid profile, HOMA-IR, leptin, and high-sensitivity C-reactive protein (hs-CRP) were assessed.

One year after surgery, significant reductions were observed in CIMT, anthropometric parameters, inflammatory biomarkers (leptin, hs-CRP), insulin resistance, ox-LDL, and PAI-1 levels, along with improvement in lipid profile. PAI-1 was positively correlated with ox-LDL (MD: 5.94, 95% CI: 4.48-7.39; p < 0.001), and ox-LDL was a predictor of PAI-1 levels (MD: 0.05, 95% CI: 0.04-0.06; p < 0.001). In ROC analysis for predicting CIMT ≥ 1 mm, ox-LDL showed acceptable discriminative ability (AUC: 0.73; sensitivity: 82.1%, specificity: 64.8%), while PAI-1 demonstrated limited performance (AUC: 0.64; sensitivity: 48.7%, specificity: 79.6%).

Weight loss following SG was associated with improvement in inflammatory, oxidative, and fibrinolytic biomarkers. Ox-LDL was more strongly linked to CIMT than PAI-1, which showed limited predictive value. Further studies are needed to evaluate the relationship between CIMT and other fibrinolysis biomarkers such as thrombin-activatable fibrinolysis inhibitor (TAFI) and D-dimer in the context of MBS.