INS and pulmonary arterial hypertension: Thirty minutes following the consumption of the mixed meal, there was a significant difference in serum insulin concentration between both surgical cohorts relative to Obese-No RYGB group (Insulin30: 132.0 ± 24.8 (symptomatic PPH group), 119.4 ± 24.9 (asymptomatic RYGB), 39.9 ± 7.4 U/L (Obese-No RYGB – P < 0.0001 both for comparison of symptomatic PPH vs Obese-No RYGB and for comparison of asymptomatic RYGB vs Obese-No RYGB).