Abstract
Background
The scale and variables linked to bariatric surgery‘s effect on dyslipidemia have
not been conclusive.
Objective
To compare the effect of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG),
and adjustable gastric banding (LAGB) on dyslipidemia
Setting
National bariatric surgery registry.
Methods
Plasma lipids and associated variables were compared at baseline and 1 year (12±4
mo) after surgery for registry patients with dyslipidemia enrolled from June 2013
to August 2014.
Results
The greatest mean total-cholesterol (TC) reduction was observed post-RYGB, 226.7±26.4
to 181.3±30.9 mg/dL (19.9%, n = 208), followed by post-SG, 227.9±24.4 to 206.7±34.2
mg/dL (8.9%, n = 1515; P<.001). Normal TC levels of below 200 mg/dL were achieved by 76% post-RYGB patients
compared with 43.5% post-SG patients (odds ratio [OR] = 6.24, 95% confidence interval
[CI]: 3.69–10.53) and 25.6% post-LABG patients (OR = 9.66, 95% CI: 4.11–22.67; P<.01). Although equivalent patterns were observed for low-density-lipoprotein cholesterol
(LDL), the levels of high-density-lipoprotein cholesterol (HDL) were most improved
post-SG, reaching normal levels in 58.1% of SG male patients versus 39.5% of RYGB
male patients (OR = 1.56, 95% CI: 1.04–2.35), (P = .02). The lowering of triglyceride levels by approximately 75% was comparable after
SG and RYGB procedures. The type of surgery was the strongest independent predictor
for all lipid level improvements or remissions. Male sex was an independent predictor
for LDL normalization only (OR = 1.88, 95% CI: 1.24–2.85). Excess weight loss offered
no meaningful prediction for lipid improvement (OR = 1.01–1.03).
Conclusion
Particular types of bariatric surgeries had different effects on dyslipidemia, independent
of weight loss. 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.
Keywords
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Article info
Publication history
Published online: March 23, 2017
Accepted:
March 8,
2017
Received in revised form:
March 6,
2017
Received:
December 10,
2016
Identification
Copyright
© 2017 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
