Victor E. A. Gerdes

Academisch Medisch Centrum Universiteit van Amsterdam | AMC · Department of Internal Medicine

The pathophysiology of obesity and obesity-related diseases such as type 2 diabetes mellitus (T2DM) is complex and driven by many factors. One of the most recently identified factors in development of these metabolic pathologies is the gut microbiota. The introduction of affordable, high-throughput sequencing technologies has significantly expanded...

Objective: It has been suggested that weight reduction and improvements in satiety after Roux-en-Y gastric bypass (RYGB) are partly mediated via postoperative neuroendocrine changes. Glucagon-like peptide-1 (GLP-1) is a gut hormone secreted after food ingestion and is associated with appetite and weight reduction, mediated via effects on the centr...

Aim: To investigate the effect of basic periodontal therapy (BPT) with antimicrobials (AM) on the parameters of metabolic syndrome (MetS) (waist circumference, systolic/diastolic blood pressure [BP], HDL-cholesterol, triglycerides, glucose). Methods: 110 periodontitis patients without known comorbidities and unaware of possible MetS, were random...

TAM receptors (Tyro3, Axl, and Mer) have been implicated in regulation of innate immunity. Circulating levels of TAM receptor soluble forms (sTyro3, sAxl, sMer) are related to autoimmune disorders. We investigated levels of TAM and their ligand protein S in patients with diabetes. Urinary and plasma levels of protein S, sTyro3, sAxl, and sMer were...

In the current study we examined an associative learning mechanism by which food cues (signaling low- versus high-calorie food) can bias instrumental responses directed toward those foods. To investigate the clinical relevance of this mechanism, we used a computerized Pavlovian-to-instrumental transfer task and compared performance of 19 severely o...

Table S1 Characteristics of postoperative revisional patients and controls who underwent previous bariatric surgery (Word document) Table S2 Scores on the Gastrointestinal Symptom Rating Scale for postoperative revisional patients and controls who underwent previous bariatric surgery (Word document) Table S3 Statistical analysis of difference in...

Background: Antineoplastic agents can provoke hyperglycemia in cancer patients with and without diabetes mellitus. We systematically reviewed the impact of hyperglycemia on the efficacy of chemotherapy. Methods: MEDLINE was searched for preclinical intervention studies which compared chemotherapy response in hyperglycemic and euglycemic conditio...

Objective The early diagnosis of (pre)diabetes mellitus is essential for the prevention of diabetes complications. It has been suggested that gum disease (periodontitis) might be an early complication of diabetes and may be a useful risk indicator for diabetes screening. Therefore, a dental office could be a good location for screening for (pre)dia...

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for morbid obesity, but might aggravate gastrointestinal complaints and food intolerance. The long-term prevalence of these symptoms has not been well studied. Methods: In a cross-sectional study, all patients who underwent primary LRYGB from May to October 2012...

Theoretical considerations and empirical results suggest that attachment quality is relevant to obesity. This study used meta-analytic methods to systematically examine the empirical, peer-reviewed evidence regarding the relationship between attachment quality and body mass index (BMI) in separate metaanalyses for children and adults. Relevant peer...

Background: In a recent study of patients using vitamin K antagonists, those with low free thyroxin (FT4) levels within the normal range had a 3- to 5-fold increased risk of major bleeding. We tested the hypothesis that low levels of preoperative FT4 within the reference range are associated with an increased risk of major bleeding during and afte...

Background The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown. Methods In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome...

Résumé Des considérations théoriques et des résultats empiriques suggèrent que la qualité de l’attachement est reliée à l’obésité. Dans le cadre de cette étude, on a eu recours à des méthodes méta-analytiques pour examiner systématiquement les données empiriques d’études soumises à un examen par les pairs, portant sur la relation entre la qualité d...

Background: Roux-en-Y gastric bypass (RYGB) causes several alterations in gastrointestinal function. We hypothesized that levels of three commonly used fecal tests change after RYGB. Methods: Fecal levels of calprotectin, elastase, and alpha-1-antitrypsin were determined in 122 patients without signs of gastrointestinal disease 1 to 2 years afte...

Introduction: Aldosterone seems to influence the haemostatic system by several mechanisms and to increase the risk of thrombosis. The objective of this meta-analysis was to assess the impact of inhibition of the mineralocorticoid receptor due to the use of mineralocorticoid receptor antagonists (MRAs) on venous and arterial thrombosis, bleeding eve...

This study aimed to compare the effectiveness and safety of intermediate-acting insulin (IMI) titrated on body weight and glucocorticoid dose to short-acting sliding scale insulin (SSI) in patients on recurrent high dose glucocorticoid-containing chemotherapy. We enrolled 26 patients with type 2 diabetes mellitus or random blood glucose > 12 mmol/L...

Objective: Hyperthyroidism is associated with a hypercoagulable state, but the underlying mechanism is unknown. Patients with resistance to thyroid hormone (RTH) due to defective thyroid hormone receptor β (TRβ) exhibit elevated circulating thyroid hormones (TH) with refractoriness to TH action in TRβ-expressing tissues. We tested the hypothesis t...

Background: Diabetic nephropathy (DN) represents the leading cause of end stage renal disease. The endothelial protein C receptor (EPCR) and its ligand (activated protein C) have been shown to ameliorate the phenotype of DN in mice. EPCR activity can be regulated by proteolytic cleavage involving A Disintegrin and Metalloproteinases (ADAM) yieldin...

The best diagnostic strategy to confirm or exclude pulmonary embolism (PE) suspicion needs an appropriate combination of clinical assessment, plasma D-dimer measurement, and computed tomographic pulmonary angiography (CTPA). CTPA should be used with caution in some patient groups, such as patients with known allergy to contrast media, those with se...

The majority of patients with diabetes remain poorly controlled. The primary aim of this study was to explore determinants that influence the decision making behavior of diabetes caregivers to adjust the basal insulin dose of their patients with type 2 diabetes.

Skin autofluorescence (AF), a non-invasive measure of the level of tissue accumulation of AGEs, has been associated with the presence of diabetes complications.

The prevalence of diabetes mellitus and cardiovascular disease varies between ethnic populations. Genetic, socioeconomical, and cultural factors may contribute to disparities in variables of diabetes management. We investigated, in a secondary care setting, whether differences exist in the achievement of treatment goals, the consumption of care, an...

Viral hepatitis may promote the development of venous thromboembolism (VTE) and, more specifically, portal vein thrombosis (PVT). In this narrative review, we summarize the clinical data and discuss the possible pathogenetic roles of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and hepatitis A, B, and C viruses (HAV, HBV, HCV) in the occurrence...

Diabetes care includes annual evaluation of micro- and macrovascular complications, however, oral pathologies are not included. We studied retrieving oral health information, in particular periodontal disease, from the dentist and studied the association between the reported periodontal condition and variables of both diabetes and dental care. Duri...

Achtergrond Laaggedoseerd aspirine lijkt geen voordeel te bieden bij de primaire preventie van cardiovasculaire ziekte bij diabetes mellitus type 2 (DM2). Het anti-plaatjeseffect kan afnemen door hyperglycemie of inadequate dosering van aspirine. Doelstellingen Het bestuderen van de effecten van zowel glycemische controle als toenemende aspirine op...

Treatment with glucocorticoids for neoplasms and inflammatory disorders is frequently complicated by glucocorticoid induced hyperglycaemia (GCIH). GCIH is associated with adverse outcomes and its treatment has short term and long term benefits. Currently, treatment targets and modalities depend on local protocols and habits of individual clinicians...

To verify the safety and effectiveness of traditional Chinese red yeast rice-extract (RYR) for reduction of LDL cholesterol. Systematic literature review and meta-analysis. Medline and EMBASE were searched until November 2014. We selected randomized studies in which RYR with a known content of the active substance monacolin K was tested against pla...

Following bariatric surgery, patients are expected to implement diet and lifestyle changes that may be imitated by cohabitating family members. We hypothesize that cohabitating family members will lose weight and improve their eating behavior within 1 year after surgery. In this observational prospective study, family members of patients who had ga...

Aims: Skin autofluorescence (AF) has been associated with complications of diabetes. We evaluated the influence of skin color and ethnicity on the association between skin AF and the presence of diabetes-related complications. Materials and methods: In a multiethnic type 2 diabetes cohort we investigated all patients with available skin AF measu...

For the detection of unwanted outcomes of new interventions, physicians rely on adverse event reporting. We attempt to quantify the reported incidence of venous thromboembolism (VTE) and arterial thrombosis (AT) in randomized clinical trials (RCTs), and evaluate the extent of under-reporting. We selected all therapeutic RCTs published in the four h...

Introduction There is lack of data on the pharmacodynamics of low-molecular-weight heparins in obese patients. Background The aims of this study are to investigate the correlation between anti-factor Xa (anti-Xa) levels and body weight with fixed-dose enoxaparin after bariatric surgery and to investigate the percentage of patients that reach the...

Objective: Early diagnosis of (pre)diabetes mellitus is essential for the prevention and/or treatment of diabetes and diabetes complications. Several risk indicators have been proposed by the American Diabetes Association for selective diabetes screening. In the literature, it has been suggested that periodontitis might be an early complication of...

Aim: To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements. Methods: We developed narrative vignettes describing clinical scenarios of patients receiving basal insulin ther...

Background: Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whether attachment representations are associated wi...

In the May edition of The Nederlands Tijdschrift voor Tandheelkunde the editorial commentary was devoted to the question to what extent the treatment of periodontitis in patients with diabetes mellitus is worthwhile. B.G. Loos, W.J. Teeuw, V. Gerdes and F. Abbas offer a response to this commentary and argue that the treatment of periodontitis in pa...

Background: Quality of life after bariatric surgery may, among other things, depend on patients' attachment representations such as anxiety about rejection and abandonment (attachment anxiety) and avoidance of intimacy and interdependence (attachment avoidance). The aim of this study was to examine whether attachment representations, independent of...

Objective: The presence of mental health problems and limitations in physical functioning is high in patients suffering from morbid obesity. The purpose of the current study was to examine the mediating role of coping style in the relationship between attachment representations and mental health and physical functioning in a morbidly obese populat...

Hyperthyroidism is associated with procoagulant changes in the haemostatic system. At present, it is uncertain whether this leads to an increased risk of venous and÷ or arterial thrombosis. Only a few small studies have investigated this association but due to methodological limitations it is not possible to draw any definitive conclusions at this...

The association between overt hypothyroidism and atherosclerotic risk factors, especially hypertension and dyslipidemia, is clear. To date, only a few small and methodologically flawed epidemiologic studies have investigated the relationship between hypothyroidism and stroke, precluding definitive conclusions. In the current issue of Neurology®, Ka...

Studies suggest that postoperative complications are a risk factor for venous thromboembolism (VTE) after bariatric surgery. Knowledge of factors associated with a higher risk of VTE after bariatric surgery may be essential to select patients who may benefit from either prolonged or intensified thrombosis prophylaxis. The aim of this study is to de...

An excess of thyroid hormone leads to a prothrombotic state; however, the underlying pathophysiological mechanisms remain unknown. As evidence points towards an extensive "cross-talk" between the inflammatory and coagulation cascade, inflammation has been claimed as a possible mechanism through which different risk factors trigger venous thrombus f...

Thyroid hormone affects the coagulation system, but its effect on clinical disease is not clear. We determined the associations between levels of free thyroxine (FT4), thyroid stimulating hormone (TSH) and thyroid peroxidase antibodies (antiTPO) with levels of coagulation factors and the risk of venous thrombosis. In a large population based case-c...

Background: Annually, approximately 1-3% of patients treated with vitamin K antagonists (VKA) suffer from major haemorrhage. Since high levels of free thyroxine (fT4) are associated with increased thrombosis risk, the aim was to assess whether low levels of fT4 contribute to major haemorrhage in patients under VKA treatment. Methods: The FACTORS...

This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists' evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surgery completed questionnaires to measure adult atta...

Background There is accumulating evidence that rheumatoid arthritis (RA) should be considered as prothrombotic state, explaining the increased risk of thromboembolic events. Suppressing inflammation could reduce this hypercoagulability. COBRA, the combination of step-down prednisolone, methotrexate and sulfasalazine (SSZ) is an effective antirheuma...

5 Obesity may be a factor contributing to mental health in patients seeking bariatric surgery. Whether a person uses mental healthcare may have its roots in attachment behavior. The present study (N = 260) identified that attachment anxiety was associated with more mental healthcare visits (OR = 1.86, 95% CI = 1.11–2.54, p = 0.02), present use of m...

Numerous case reports have been published on acquired von Willebrand syndrome (aVWS) in patients with hypothyroidism, but no prospective studies have been published. The aim of this study was to investigate laboratory and clinical characteristics of aVWS in patients with newly diagnosed overt hypothyroidism. An observational cohort study was perfor...

Systematic review and meta-analyses to study the robustness of observations that treatment of periodontitis improves the atherosclerotic profile. Literature was searched in Medline-PubMed, Cochrane CENTRAL and EMBASE, based on controlled periodontal intervention trials, including also a non-intervention group. Data were extracted and meta-analyses...

Background: CT pulmonary angiography (CTPA) is commonly used as the first imaging test in the diagnostic workup of patients with suspected pulmonary embolism (PE). Other CTPA findings may provide an alternative explanation for signs and symptoms in these patients, but the clinical impact is not clear. Methods: In 203 consecutive patients with su...

Renal transplant recipients are at increased risk of venous thromboembolic events, which is in part caused by their treatment with maintenance immunosuppressive drugs. Because we observed an increased incidence of venous thromboembolic events in renal transplant recipients treated with the mTOR inhibitor (mTORi) everolimus, we aimed to identify pro...

Several studies conducted in the USA have demonstrated that the effectiveness of bariatric surgery differs between patients from African and European origin. However, little is known on differences in outcomes after bariatric surgery between individuals from other ethnic backgrounds. In this retrospective study, we found that, in terms of weight lo...

Background: In Klippel-Trenaunay syndrome (KTS), a congenital combined vascular (capillary, venous and lymphatic) malformation with localised disturbed growth, venous thromboembolisms (VTEs) are frequently reported in small cohorts. Design and methods: We quantified the frequency of VTE by screening a large KTS-patient cohort with duplex compres...

Endocrine diseases have been associated with cardiovascular events. Both altered coagulation and fibrinolysis markers and thrombotic disorders have been described in several endocrine diseases. This review summarizes the evidence on the influence of thyroid diseases, cortisol excess and deficiency, pheochromocytoma, hyperparathyroidism, hyperaldost...

The global obesity epidemic is also affecting the Netherlands, paralleled by a proportional increase in the number of morbidly obese persons. Bariatric surgery has been included as a treatment for morbid obesity in the Dutch Guideline for Obesity (2008). Nonetheless, bariatric surgery is applied in only a limited number of morbidly obese subjects i...

AimsPatients with idiopathic venous thromboembolism (VTE) have a high recurrence risk during and after stopping anticoagulant treatment. Several studies suggest that treatment with statins reduces the incidence of a first episode of VTE, but data on the effects in patients with a previous episode are lacking. We examined the effect of statin therap...

Introduction: Little is known about the natural history of clot resolution in the initial weeks of anticoagulant therapy in patients with acute pulmonary embolism (PE). Clot resolution of acute PE was assessed with either computed tomography pulmonary angiography scan (CT-scan) or perfusion scintigraphy scan (Q-scan) after 3 weeks of treatment. M...

Patients with venous-thromboembolism (VTE) and myocardial infarction (MI) have elevated prothrombin fragment 1+2 (F1+2) levels. In patients with postoperative VTE, urinary F1+2 (uF1+2) was higher than in individuals without VTE. To explore the relationship between plasma and uF1+2 we performed a pilot study in patients with thrombotic events and he...

Background: Recently, endogenous glucocorticoid excess has been identified as a risk factor for VTE. Whether exogenous use of glucocorticoids is associated with an increased risk of VTE is unclear. We aimed to quantify the risk of symptomatic pulmonary embolism (PE) in patients using corticosteroids. Methods: A case-control study using the PHARM...

Endocrine disorders affect both the coagulation and fibrinolytic systems, and have been associated with the development of cardiovascular diseases. Thrombin-activatable fibrinolysis inhibitor (TAFI) is a link between coagulation and the fibrinolytic system. The aim of this study was to determine the effect of thyroid hormone excess and deficiency o...

Although the incidence of pulmonary embolism (PE) increases with age from 1 per 10,000 in childhood to nearly 8 per 1000 in older-aged patients [1], the prevalence of objectively proven PE in patients with suspected PE is relatively low: between 20-30% [2;3]. Computerized tomographic (CT-) scanning in suspected PE has a high sensitivity, ranging be...

Viral infections are associated with coagulation disorders. All aspects of the coagulation cascade, primary hemostasis, coagulation, and fibrinolysis, can be affected. As a consequence, thrombosis and disseminated intravascular coagulation, hemorrhage, or both, may occur. Investigation of coagulation disorders as a consequence of different viral in...

Several coagulation and fibrinolytic parameters appear to be affected by thyroid hormone excess; however, the net effect on the haemostatic system remains unclear. We aimed to update our previous review and systematically summarise and meta-analyse the data by assessing the effects of thyrotoxicosis on the coagulation and fibrinolytic system in viv...

Background: Obesity is an independent risk factor for hypertension and chronic kidney disease. During the first months after bariatric surgery, an improvement of sodium excretion has been described. The aim of this work was to study the influence of bariatric surgery on sodium excretion at more than a year after the intervention. Methods: Patien...

It has been postulated that the effectiveness of bariatric surgery varies between ethnic groups. However, data regarding this topic are inconclusive, as most studies included few patients from minority groups. We conducted a meta-analysis to determine the difference in percentage of excess weight loss (%EWL) 1-2 years after bariatric surgery in peo...

The pituitary hormone prolactin is thought to influence coagulation. We aimed to study the relation between prolactin levels, coagulation factors and risk of venous thrombosis (VT). We used data from a large population based case-control study into aetiology of first VT (MEGA-study). Prolactin levels were determined in 2,068 patients with VT and 2,...

Venous thromboembolism (VTE) is a multicausal disease. Among minor risk factors, acute infections in general are associated with a transient increased risk of VTE. However, acute hepatitis is usually not reported as a potential risk factor for VTE. Recent studies suggest a possible role of viral hepatitis in the development of VTE and, in particula...

Hyperthyroidism is associated with several changes in the haemostatic system resulting in a hypercoagulable state. It is uncertain at this stage whether this leads to an increased risk of venous thromboembolism (VTE). The aim of this retrospective cohort study was to determine the risk of VTE in all patients with overt hyperthyroidism and to compar...

Hyperthyroidism is associated with increased thrombosis risk, and fibrin clot structure determines susceptibility to vascular thrombotic events. Our objective was to investigate clot formation and lysis in hyperthyroidism using observational and interventional studies. Ex vivo fibrin clot structure/fibrinolysis and plasma levels of thrombotic/infla...

Currently there are over 740,000 patients with diabetes mellitus in the Netherlands, and this number will increase further in the coming years. Approximately 90% of patients has type 2 diabetes, a metabolic disorder that is often associated with obesity, hypertension and increased cholesterol levels. Treatment of diabetes mellitus is essential to r...

Low-dose aspirin seems to offer no benefit in the primary prevention of cardiovascular disease in type 2 diabetes mellitus (DM2). The anti-platelet effect may be diminished by poor glycemic control or inadequate dosing of aspirin. To study the effects of both glycemic control and increasing aspirin dose on platelet response to aspirin in DM2 patien...

We describe 2 patients, a 49-year-old man presenting with dyspnoea and fatigue, and a 50-year-old woman referred for hypercholesterolaemia and hypertension. Both patients appeared to have hypothyroidism-induced dyslipidaemia. The lipid abnormalities resolved completely following thyroid hormone replacement therapy. Hypothyroidism is a well-known ca...

In dit hoofdstuk komt de relatie tussen parodontitis en hart- en vaatziekten aan de orde. Neem een 54-jarige patiënt met onbehandelde, gegeneraliseerd ernstige parodontitis in gedachten. De vraag is of deze chronische aandoening, hoogstwaarschijnlijk reeds jaren aanwezig, systemische effecten heeft en een risico vormt voor de conditie van hart en b...

Hemophilia A patients have a lower cardiovascular mortality rate than the general population. Whether this protection is caused by hypocoagulability or decreased atherogenesis is unclear. To evaluate atherosclerosis and endothelial function in hemophilia A patients with and without obesity as well as in matched, unaffected controls. Fifty-one obese...

Venous thrombosis has frequently been reported in patients with endogenous Cushing's syndrome (CS). The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) in patients with CS prior to treatment and after surgery. We conducted a multicenter cohort study at all university medical centers in The Netherlands. Consecutive pa...

Several hemostatic abnormalities have been reported in hyperthyroidism, but the overall effect of thyroid hormone excess on coagulation and fibrinolysis is unclear. Our aim was to assess whether the use of supraphysiological doses of levothyroxine leads to coagulation activation and inhibition of fibrinolysis. Healthy volunteers were randomized to...