title: Exploring the impact of bariatric surgery on high density lipoprotein.
abstract: Low HDL cholesterol is an independent cardiac risk factor. A general efficacy gradient exists for the resolution of cardiovascular risk factors after bariatric surgery (i.e., biliopancreatic diversion [BPD]>Roux-en-Y gastric bypass [RYGB]>sleeve gastrectomy [SG]>adjustable gastric banding [AGB]). However, a review of high level of evidence clinical studies shows a different hierarchy for the effect of bariatric surgery on HDL (i.e., RYGB=SG>BPD, AGB). Surgically induced weight loss effectively reverses many steps in HDL metabolism that have been altered with obesity. Furthermore, enterocytes contribute to HDL levels through the synthesis of apolipoproteins A-IV and A-I. RYGB and SG that preserve the small intestine (particularly the jejunum) lead to a significant rise in HDL. However, when the small intestinal contribution does not reinforce the weight loss dependent mechanisms (e.g., after BPD and AGB), only a modest rise in HDL occurs. Further experimental and clinical studies are required to better delineate the issue.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zelisko
authors.affiliation: Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: schauep@ccf.org.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D016632:Apolipoprotein A-I / Q000378:metabolism; D001054:Apolipoproteins A / Q000378:metabolism; D050110:Bariatric Surgery / Q000379:methods; D008076:Cholesterol, HDL / Q000097:blood*; D006801:Humans; D009765:Obesity / Q000097:blood* / Q000601:surgery; D015431:Weight Loss
chemical_list: D016632:Apolipoprotein A-I; D001054:Apolipoproteins A; D008076:Cholesterol, HDL; C022205:apolipoprotein A-IV
keywords: Apolipoprotein; Bariatric surgery; Biliopancreatic diversion; Cholesterol; Diabetes; Gastric banding; Gastric bypass; HDL; High density lipoprotein; LDL; RYGB; Sleeve gastrectomy; Triglyceride