IM - ORIGINAL Inflammatory and prothrombotic parameters in normotensive non-diabetic obese women: effect of weight loss obtained by gastric banding Massimo Cugno • Roberto Castelli • Daniela Mari • Enrico Mozzi • Marco Antonio Zappa • Massimo Boscolo-Anzoletti • Giancarlo Roviaro • Pier Mannuccio Mannucci Received: 4 October 2010 / Accepted: 5 January 2011 / Published online: 20 January 2011 Ó SIMI 2011 Abstract Hypertension and diabetes are known risk factors for obesity-related thrombosis, but several studies have shown that obesity is characterised by a potentially prothrombotic inflammatory state because of activated coagulation and impaired fibrinolysis. In order to verify if obese patients—unaffected by hypertension, diabetes, dyslipidemia, cigarette smoking or inflammatory dis- eases—show increased prothrombotic markers and whether the weight loss induced by gastric banding normalises such parameters. Plasma levels of C reactive protein (CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (VWF) and factor VII (FVII) were measured in 25 women with isolated obesity prior to, as well as 3, 6 and 12 months subsequent to gastric banding. Twenty-five healthy women served as a baseline control group. The obese women had higher CRP (p = 0.0001), fibrinogen (p = 0.014), PAI-1 (p = 0.003), VWF (p = 0.004) and FVII levels (p = 0.0001) than the normal controls, and their body mass index (BMI) positively cor- related with CRP (r = 0.462, p = 0.02), fibrinogen (r = 0.426, p = 0.04) and PAI-1 (r = 0.468, p = 0.02). Twelve months after gastric banding, the median BMI had decreased from 40.0 to 34.9 (p = 0.0001); CRP from 4.18 to 1.69 lg/ml (p = 0.01); fibrinogen from 389 to 318 mg/dl (p = 0.0001); PAI-1 from 32.1 to 12.0 UI/ml (p = 0.003); VWF from 144 to 120% (p = 0.0001); and FVII from 134 to 112% (p = 0.002). Even in the absence of major cardiovascular risk factors, obese patients are characterised by a prothrombotic state. The weight loss induced by gastric banding decreases the parameters of inflammation, coagulation and impaired fibrinolysis, thus potentially reducing the thrombotic risk. Keywords Obesity Á Coagulation Á Inflammation Á Gastric banding Á Thrombotic risk Introduction Obesity and being overweight are associated with an increased risk of cardiovascular diseases, such as coronary heart disease (CHD) [1, 2], peripheral arterial disease (PAD), stroke, and venous thromboembolism (VTE) [3, 4], but it is still debated as to whether obesity is an indepen- dent risk factor or if it acts through its association with other known risk factors such as insulin resistance/diabetes, hypertension and dyslipidemia. Recent studies report that the mechanisms by which obesity may cause a prothrombotic state include inflam- mation and the activation of coagulation [5–8]. Adipose tissue secretes hormones, cytokines and growth factors that directly affect inflammation and induce oxidative stress, endothelial dysfunction, increased coagulant activity, and M. Cugno (&) Á R. Castelli Á M. Boscolo-Anzoletti Á P. M. Mannucci Department of Internal Medicine, Fondazione IRCCS Ca ` Granda, Ospedale Maggiore Policlinico, University of Milan, Via Pace 9, 20122 Milan, Italy e-mail: massimo.cugno@unimi.it D. Mari Geriatric Unit, Fondazione IRCCS Ca ` Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy E. Mozzi Á M. A. Zappa Á G. Roviaro Department of Surgical Sciences, Fondazione IRCCS Ca ` Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy P. M. Mannucci Scientific Direction, IRCCS Ca ` Granda, Ospedale Maggiore Policlinico, Milan, Italy 123 Intern Emerg Med (2012) 7:237–242 DOI 10.1007/s11739-011-0522-x