Effect of bariatric surgery on HDL-mediated cholesterol efflux capacity

O Castañer; K A Pérez-Vega; S Álvarez; S Vázquez; A Casajoana; G Blanchart; S Gaixas; H Schröder; M D Zomeño; I Subirana; D Muñoz-Aguayo; M Fitó; D Benaiges; A Goday; A Oliveras

doi:10.3389/fcvm.2024.1469433

Effect of bariatric surgery on HDL-mediated cholesterol efflux capacity

Front Cardiovasc Med. 2024 Nov 7:11:1469433. doi: 10.3389/fcvm.2024.1469433. eCollection 2024.

Authors

O Castañer^{1

2}, K A Pérez-Vega^{1

3}, S Álvarez⁴, S Vázquez⁴, A Casajoana^{1

5}, G Blanchart¹, S Gaixas¹, H Schröder^{1

2}, M D Zomeño^{1

3

6}, I Subirana^{1

7

8}, D Muñoz-Aguayo^{1

3}, M Fitó^{1

3}, D Benaiges^{1

9

10

11}, A Goday^{1

9

12}, A Oliveras^{4

10}

Affiliations

¹ Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Research Institute, Barcelona, Spain.
² Network Biomedical Research Center Consortium (CIBER), M.P. Epidemiology and Public Health (CIBEResp), Instituto de Salud Carlos III, Madrid, Spain.
³ Network Biomedical Research Center Consortium (CIBER), M.P. Pathophysiology of Obesity and Nutrition (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.
⁴ Nephrology Department, Hospital del Mar, Barcelona, Spain.
⁵ Esophagogastric and Bariatric Surgery Department, General Surgery Service, Hospital del Mar, Barcelona, Spain.
⁶ Department of Nutrition, Ramon Llull University, Barcelona, Spain.
⁷ Network Biomedical Research Center Consortium (CIBER), M.P. Cardiovascular Diseases (CIBERcv), Instituto de Salud Carlos III, Madrid, Spain.
⁸ Cardiovascular Epidemiology and Genetics Research Group, IMIM, Barcelona, Spain.
⁹ Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain.
¹⁰ Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain.
¹¹ Department of Endocrinology and Nutrition, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Spain.
¹² Department of Medicine, Autònoma de Barcelona University, Bellaterra, Spain.

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.

Keywords: HDLc; cholesterol efflux capacity; lipid profile; obesity; weight loss.

Grants and funding

The author(s) declare financial support received for the research, authorship, and/or publication of this article. Projects CP21/00097 and PI20/00012 were funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union and by Agència de Gestió d’Ajuts Universitaris i de Recerca (2021 SGR 00144). The study was also supported by the Spanish Society of Nephrology and by the Instituto de Salud Carlos III RedinRen (RD16/0009/0013).