Acute and Chronic Impact of Biliopancreatic Diversion with Duodenal Switch Surgery on Plasma Lipoprotein(a) Levels in Patients with Severe Obesity

Abstract

Background

Elevated lipoprotein(a) (Lp(a)) level is an independent risk factor for cardiovascular diseases. Lifestyle intervention studies targeting weight loss revealed little to no significant changes in Lp(a) levels. The impact of interventions that induce substantial weight loss, such as bariatric surgery, on Lp(a) levels is currently unclear.

Objective

To determine the acute and long-term impact of bariatric surgery on Lp(a) levels in patients with severe obesity.

Methods

Sixty-nine patients with severe obesity underwent biliopancreatic diversion with duodenal switch (BPD-DS) surgery. The lipid profile was evaluated and Lp(a) levels were measured before surgery and at 6 and 12 months after BPD-DS surgery.

Results

Median Lp(a) levels at baseline were 11.1 (4.1–41.6) nmol/L. Six months and 12 months after the BDP-DS surgery, we observed an improvement of lipid profile. At 6 months, we observed a 13% decrease in Lp(a) levels (9.7 (2.9–25.6) nmol/L, p < 0.0001) but this decrease was not sustained at 12 months (11.1 (3.9–32.8) nmol/L, p = 0.8). When the patients were separated into tertiles according to Lp(a) levels at baseline, we observed that the Lp(a) reduction at 12 months after BPD-DS surgery remained significant but modest in patients of the top Lp(a) tertile.

Conclusion

Our results suggest that BPD-DS surgery modestly reduces Lp(a) levels in the short term (6 months) in patients with severe obesity but this improvement is sustained over time only in patients with higher Lp(a) levels.

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Funding

This work was supported by operating grants from the Canadian Institutes of Health Research. We would like to thank Sylvain Pouliot for his technical help. M-E.P. is a recipient of a studentship from the Fonds de Recherche du Québec-Santé (FRQS). P.M. holds a FRQS research Chair on the Pathobiology of Calcific Aortic Valve Disease. B.J.A. holds a junior scholar award from the Fonds de Recherche du Québec: Santé (FRQ-S). P.P. is a senior scholar from the FRQ-S. A.C.C. is the recipient of the GlaxoSmithKline Chair in Diabetes of the Université de Sherbrooke.

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Correspondence to Benoit J. Arsenault.

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The ethics committee of the IUCPQ approved the experimental protocol and all patients gave their written informed consent before being included in the study.

Conflict of Interest

André Tchernof and Laurent Biertho report grants from Johnson & Johnson Medical and grants from Medtronic, during the conduct of the study. All other authors declare that they have no conflict of interest.

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Després, AA., Piché, ME., Auclair, A. et al. Acute and Chronic Impact of Biliopancreatic Diversion with Duodenal Switch Surgery on Plasma Lipoprotein(a) Levels in Patients with Severe Obesity. OBES SURG 30, 3714–3720 (2020). https://doi.org/10.1007/s11695-020-04450-2

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Keywords

  • Lipoprotein(a)
  • Severe obesity
  • Bariatric surgery
  • Low-density lipoprotein cholesterol
  • Statins