Effect of bariatric surgery on HDL-mediated cholesterol efflux capacity

Castañer, Olga; Pérez Vega, Karla Alejandra; Álvarez, Sara; Vázquez, Susana; Casajoana, Anna; Blanchart, Gemma; Gaixas, Sònia; Schröder, Helmut, 1958-; Zomeño Fajardo, Maria Dolores; Subirana Cachinero, Isaac; Muñoz Aguayo, Daniel; Fitó Colomer, Montserrat; Benaiges Foix, David; Goday Arno, Alberto; Oliveras, Anna

doi:http://dx.doi.org/10.3389/fcvm.2024.1469433

Effect of bariatric surgery on HDL-mediated cholesterol efflux capacity

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Castañer O, Pérez-Vega KA, Álvarez S, Vázquez S, Casajoana A, Blanchart G, Gaixas S, Schröder H, Zomeño MD, Subirana I, Muñoz-Aguayo D, Fitó M, Benaiges D, Goday A, Oliveras A. Effect of bariatric surgery on HDL-mediated cholesterol efflux capacity. Front Cardiovasc Med. 2024 Nov 7:11:1469433. DOI: 10.3389/fcvm.2024.1469433

Abstract

Background: Bariatric surgery (BS) is the most effective intervention for severe obesity, leading to sustained weight loss, reduced obesity-related comorbidities, and cardiovascular mortality. Aim: To assess changes in high-density lipoprotein (HDL) functions [cholesterol efflux capacity (CEC) and anti-inflammatory capacity] at different follow-up times in patients with severe obesity undergoing BS. Methods: A prospective observational study within a cohort of consecutively enrolled patients with severe obesity scheduled to undergo BS. In total, 62 participants (77% women), with a mean age of 42.1 years (SD 9.33 years) underwent BS. Regarding the surgical procedure, 27 (43.5%) underwent sleeve gastrectomy and 35 (56.5%) Roux-en-Y gastric bypass. All patients were evaluated preoperatively and at 1, 3, 6, and 12 months after surgery. Results: A decrease in body mass index and an improvement in the systemic lipid profile, indicated by reductions in total cholesterol, low-density lipoprotein cholesterol (LDLc), and remnant cholesterol, and an increase in HDL cholesterol (HDLc) was observed (all p trend < 0.001). Time-series comparisons vs. baseline showed that, in general, anthropometric measures, glycemia, total cholesterol, LDLc, and remnant cholesterol decreased at all follow-ups, whereas HDLc and triglyceride concentrations significantly improved vs. baseline from 6 months, reaching at 12 months the highest HDLc levels (29.6%, p < 0.001) and the lowest circulating triglycerides (-30%, p < 0.001). Although HDL's anti-inflammatory ability worsens after surgery, the HDL-mediated CEC linearly increased after surgery (for both p trend < 0.013). Conclusion: BS improves the lipid profile both quantitatively and qualitatively after 1 year, specifically enhancing HDL-mediated cholesterol efflux capacity, which may contribute to a reduced cardiovascular risk in individuals with severe obesity.