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Reaching LDL-C Targets in Patients with Moderate, High, and Very High Risk for Cardiovascular Disease After Bariatric Surgery According to Different Guidelines

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Abstract

Background

Cardiovascular disease (CVD) is highly prevalent in obese patients and is the leading cause of death. High levels of plasma low-density lipoprotein cholesterol (LDL-C) are associated with higher coronary artery disease (CAD) risk. The aim of the study was to assess the impact of the Roux-en-Y gastric bypass on the achievement of the currently proposed cardiovascular prevention goals after 1 year.

Patients and Methods

We performed a retrospective analysis from a prospectively built database of patients who underwent a primary Roux-en-Y gastric bypass (RYGB) from 2004 to 2018. Patients with intermediate, high, or very high risk for CVD according to the 2018 AHA/ACC or the 2019 ESC/EAS guidelines were selected. An analysis of clinical and biochemical variables in 1 year was performed. Logistic multivariate regressions were made to assess the impact of preoperative and weight loss parameters in the achievement of LDL-C goals.

Results

From 1039 patients, 70 met the selection criteria and were included in the analysis of the 2018 AHA/ACC guidelines, and 75 in the 2019 ESC/EAS guidelines. Mean decrease in LDL-C levels was 21.1 ± 40.2 mg/dL 1 year after surgery, and 29/34 patients were off medications. The percentage of patients achieving LDL-C goals according to the 2018 AHA/ACC guidelines was 27.1%, whereas according to the 2019 ESC/EAS guidelines, the percentages was 9.3%. The %TWL was associated with achieving LDL-C goals according to the 2018 AHA/ACC at 1 year.

Conclusions

RYGB induces a significant weight loss and an improvement in LDL-C levels 1 year after surgery. The number of patients that reached the goals varies according to the guidelines used and ranged from 9.3 to 27.1%.

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Abbreviations

AACE:

America Association of Clinical Endocrinologists

ACC:

American College of Cardiology

AHA:

American Heart Association

ASCVD:

Atherosclerotic Cardiovascular Disease

ASMBS:

American Society for Metabolic and Bariatric Surgery

BMI:

Body mass index

BPD:

Biliopancreatic diversion

CAD:

Coronary artery disease

CV:

Cardiovascular

CVD:

Cardiovascular disease

EAS:

European Atherosclerosis Society

ESC:

European Society of Cardiology

EWL:

Excess of weight loss

HDL-C:

High-density lipoprotein cholesterol

LDL-C:

Low-density lipoprotein cholesterol

OAGB:

One-anastomosis gastric bypass

PIB:

Partial ileal bypass

RYGB:

Roux-en-Y gastric bypass

SG:

Sleeve gastrectomy

T2D:

Type 2 diabetes

TC:

Total cholesterol

TWL:

Total weight loss

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Authors and Affiliations

  1. Clinic for Nutrition and Obesity, ABC Medical Center, 116, Sur 136, Las Américas, Álvaro Obregón, 01120, Mexico City, Mexico

    Guillermo Ponce de León-Ballesteros, Hugo A. Sánchez-Aguilar & Miguel F. Herrera

  2. Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Carlos A. Aguilar-Salinas

  3. Direccion de Nutricion, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Carlos A. Aguilar-Salinas

  4. Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Ave. Morones Prieto 3000, 64710, Monterrey, N.L., Mexico

    Carlos A. Aguilar-Salinas

  5. Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico

    Miguel F. Herrera

Authors
  1. Guillermo Ponce de León-Ballesteros
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  2. Hugo A. Sánchez-Aguilar
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  3. Carlos A. Aguilar-Salinas
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  4. Miguel F. Herrera
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Correspondence to Miguel F. Herrera.

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Ponce de León-Ballesteros, G., Sánchez-Aguilar, H.A., Aguilar-Salinas, C.A. et al. Reaching LDL-C Targets in Patients with Moderate, High, and Very High Risk for Cardiovascular Disease After Bariatric Surgery According to Different Guidelines. OBES SURG 31, 2087–2096 (2021). https://doi.org/10.1007/s11695-021-05221-3

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