Bariatric Surgery Type Predicts Dyslipidemia Effect

The type of bariatric surgery performed is the strongest predictor of all lipid level improvements or remissions among patients with dyslipidemia who undergo bariatric surgery, according to a recent study. Patients who received Roux-en-Y gastric bypass (RYGB) achieved the largest reduction in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), while patients who underwent a sleeve gastrectomy (SG) achieved the lowest levels of high density-lipoprotein cholesterol (HDL-C).

The scale and variables associated with the effect of bariatric surgery on dyslipidemia have not been conclusive. Therefore, the researchers sought to further investigate this relationship.
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In their study, the researchers assessed 208 patients who underwent RYGB, 1015 patients who underwent SG, and patients who underwent adjustable gastric banding (LAGB) from June 2013 to August 2014.

Patients’ plasma lipids and associated variables were compared at baseline and 1 year post-surgery.

Results indicated that the greatest mean TC reduction had occurred in post-RYGB patients, followed by post-SG patients. A total of 76% of post-RYGB patients had achieved normal TC levels of below 200 mg/dL, compared with 43.5% of post-SG patients and 25.6% of post-LAGB patients.

Although the researchers observed equivalent patterns for LDL-C, HDL-C levels were most improved among post-SG patients. A total of 58.1% of male SG patients had reached normal levels vs 39.5% of male RYGB patients. The lowering of triglyceride levels by approximately 75% was comparable in post-SG and post-RYGB patients.

Ultimately, the researchers found that bariatric surgery type was the strongest independent predictor for all lipid level improvements or remissions. Male sex was an independent predictor for LDL-C normalization only, while excess weight loss provided no meaningful prediction for lipid improvement.

“Particular types of bariatric surgeries had different effects on dyslipidemia, independent of weight loss,” the researchers concluded. “Overall, the RYGB achieved the biggest reduction in plasma lipids (TC and LDL), although SG did affect HDL. Our results could aid in the decision-making process regarding the most appropriate procedure for patients with dyslipidemia.”

—Christina Vogt

Reference:

Spivak H, Sakran N, Dricker D, et al. Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis. Surg Obes Rel Dis. 2017;13(7):1189-1194. doi:10.1016/j.soard.2017.03.013.