The Effect of Bariatric Surgery on Circulating Levels of Lipoprotein (a): A Meta-analysis

Abstract

Background. Obesity, especially severe obesity, is associated with a higher risk of atherosclerotic cardiovascular disease (ASCVD) morbidity and mortality. Bariatric surgery is a durable and effective weight loss therapy for patients with severe obesity and weight-related comorbidities. Elevated plasma levels of lipoprotein (a) (Lp(a)) are causally associated with ASCVD. The aim of this meta-analysis was to analyze whether bariatric surgery is associated with Lp(a) concentrations. Methods. A literature search in PubMed, Scopus, Embase, and Web of Science was performed from inception to May 1st, 2021. A random-effects model and the generic inverse variance weighting method were used to compensate for the heterogeneity of studies in terms of study design, treatment duration, and the characteristics of the studied populations. A random-effects metaregression model was used to explore the association with an estimated effect size. Evaluation of funnel plot, Begg’s rank correlation, and Egger’s weighted regression tests were used to assess the presence of publication bias in the meta-analysis. Results. Meta-analysis of 13 studies including 1551 patients showed a significant decrease of circulating Lp(a) after bariatric surgery (SMD: -0.438, 95% CI: -0.702, -0.174, p < 0.001 , I 2 : 94.05%). The results of the metaregression did not indicate any significant association between the changes in Lp(a) and duration of follow-up after surgery, reduction in body mass index, or baseline Lp(a) concentration. The reduction in circulating Lp(a) was robust in the leave-one-out sensitivity analysis. Conclusion. Bariatric surgery significantly decreases circulating Lp(a) concentrations. This decrease may have a positive effect on ASCVD in obese patients.

Diabetic Markers, Five Years after Bariatric Surgery

“… 29 Another meta-analysis study on 1551 patients demonstrated a significant reduction of serum LDL levels following bariatric surgery, especially after RYGB. 30 However, Hu et al, in a meta-analysis on 7443 subjects who underwent RYGB and SG, revealed that, in more than 3 years of follow-up, comorbidities such as dyslipidemia and hypertension had not been improved significantly. 31 Also, Coleman and co-workers, in a study of 8265 patients, found lower dyslipidemia relapse in 4 years of follow-up in RYGB versus the SG group (21% vs. 24%).…”

Differential effects of bariatric surgery and lifestyle interventions on plasma levels of Lp(a) and fatty acids

“…The Lp(a) lowering effect of RYGB, observed in this study, is in accordance with results from previous studies. A recent meta-analysis including 13 studies and 1551 adults and adolescents revealed a significant decrease in circulating Lp(a) following different types of bariatric surgery (standardized mean difference; -0.438, 95% CI: -0.702, -0.174) [ 8 ]. The heterogeneity between the studies was, however, large, and the mean (SD) Lp(a) levels at baseline ranged from 14.0 (3.65) to 258.2 (378) nmol/L.…”

“…7 Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway. 8 Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.…”

“…It has previously been shown that weight loss after energy-restricted dieting was associated with an increase in plasma Lp(a) levels in adults with or without type 2 diabetes (T2D), while plasma Lp(a) levels showed a strong tendency to decrease in patients without T2D who underwent bariatric surgery [ 7 ]. A recent meta analysis showed that bariatric surgery significantly decreased circulating Lp(a) levels, and that the decrease in Lp(a) was not associated with change in body mass index (BMI) [ 8 ].…”

The Effect of Bariatric Surgery on Circulating Levels of Monocyte Chemoattractant Protein-1: A Systematic Review and Meta-Analysis

“…Bariatric surgery is a surgical treatment primarily for obese patients, which improves metabolic and inflammatory processes as well as cardiometabolic risk factors beyond weight loss [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The types of bariatric surgery are sleeve gastrectomy (SG), laparoscopic adjustable gastric band (LAGB), Roux-en-Y gastric bypass (RYGP), biliopancreatic diversion/duodenal switch (BPD/DS), and one anastomosis gastric bypass/mini gastric bypass (OAGB/MGB) [ 16 ].…”