for Reducing Risk of Cardiovascular Disease National Lipid Association, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association Reach Consensus
Three professional societies that treat patients with high cholesterol, cardiovascular disease and obesity agree that bariatric surgery is generally safe and effective in helping patients lose significant weight, improve cholesterol and lipid levels, and reduce major risk factors for heart disease.
The American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and Obesity Medicine Association (OMA) issued the second part of its joint statement on the topic in the March/April issue of Surgery for Obesity and Related Diseases (SOARD), the official peer-reviewed journal of the ASMBS. Part 1 was published in the January/February issue of the Journal of Clinical Lipidology, the official journal of the NLA.
Shanu Kothari, MD
“We concluded that bariatric procedures improve multiple cardiovascular risk factors, including glucose metabolism, blood pressure, factors related to thrombosis, kidney function, adipocyte and adipose tissue function, inflammatory markers, and vascular markers. These procedures also improved lipid levels, which is another potential contributor to reduced cardiovascular risk,” said Shanu N. Kothari, MD, from the Gundersen Health System, one of the co-authors of the statement and immediate-past chair of the ASMBS
Clinical Issues Committee.
“This unified statement coming from the three societies is important to provide the clarity and guidance necessary for the medical community and patients to make informed decisions about the benefits and risks of the diseases they face and the risks of both treatment and of non-treatment in this specific population,” Dr. Kothari added.
The first part of the statement focused on the mechanism by which bariatric surgery affects cholesterol and lipid levels. This second statement reviewed the importance of nutrients and their absorption on lipid levels, the effects of bariatric procedures on gut hormones, lipid levels, cardiovascular disease risk factors, and the potential lipid effects of vitamin, mineral, and trace element deficiencies that may occur after bariatric procedures.
Major conclusions included: the greater the fat mass loss after bariatric surgery, the greater the improvement in lipid parameters such as triglycerides, and especially LDL cholesterol, and that bariatric procedures allow for a decrease in the use of drug treatment for dyslipidemia.
Also, HDL cholesterol may transiently decrease for the first three to six months after the procedure, which is usually followed by an increase in HDL cholesterol above the baseline value before the procedure. Finally, the authors acknowledge data are scarce regarding the effects of bariatric procedures on some of the lipid parameters of most interest to lipidologists, such as non-HDL cholesterol, apolipoprotein B, and lipoprotein particle number and remnant lipoproteins. These are areas where more study may be necessary.
Co-authors also included: Harold Bays, MD, Dan E. Azagury, MD, John M. Morton, MD, MPH, Ninh T. Nguyen, MD, Peter H. Jones, MD, Terry A. Jacobson, MD, David E. Cohen, MD, PhD, Carl Orringer, MD, Eric C. Westman, MD, MHS, Deborah B. Horn, DO, MPH, Wendy Scinta, MD, M.S, Craig Primack, MD.