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

Safwaan Adam, Yifen Liu, Tarza Siahmansur, Jan H. Ho, Shaishav S. Dhage, Rahul Yadav, John P. New, Rachelle Donn, Basil J. Ammori, Akheel A. Syed, Rayaz A. Malik, Handrean Soran, Paul N. Durrington

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)144-152
Number of pages9
JournalDiabetes and Vascular Disease Research
Issue number2
Early online date23 Apr 2019
Publication statusPublished - 2019


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


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