Abstract
Background Obesity is related to dyslipidemia and increased circulating oxidated LDL (ox-LDL) concentrations that may predispose to atherosclerosis. Bariatric surgery may lower the risk of cardiovascular mortality. Elevated plasma ox-LDL has been associated with atherogenesis and atherosclerotic cardiovascular disease (ASCVD) events. The aim of this meta-analysis was to investigate the impact of bariatric surgery on proatherogenic circulating ox-LDL levels in patients with severe obesity. Methods Four databases were systematically searched from inception to May 1, 2021. Also, to clarify the heterogeneity of studies with regard to treatment duration, research design, and the demographic features, a random-effects model and the generic inverse variance weighting approach were utilized. To determine the association with the estimated effect size, a random-effect meta-regression approach was performed. Finally, a meta-regression analysis was conducted to explore the influence of, respectively, baseline and changes in body mass index (BMI), baseline ox-LDL, and postsurgery follow-up period with the estimated effect size of surgery on ox-LDL levels. Results Meta-analysis of 11 studies including 470 subjects showed a significant decline in circulating ox-LDL following bariatric surgery (SMD: -0.971, 95% CI: -1.317, -0.626, p < 0.001, I2: 89.43%). The results of meta-regression did not show any significant association between the changes in ox-LDL after bariatric surgery and baseline BMI, duration of follow-up or baseline ox-LDL values. However, there was a significant association between ox-LDL alteration and percentage of BMI change. Conclusion Bariatric surgery in patients who had severe obesity causes a decrease of circulating ox-LDL that was apparently dependent in BMI changes.
Highlights
Obesity is a major risk factor for impaired glucose tolerance, insulin resistance, and type 2 diabetes mellitus, atherosclerotic cardiovascular disease (ASCVD) [1]
11 studies which evaluated the levels of ox-low-density lipoprotein (LDL) after bariatric surgery were included (Table 1)
Meta-analysis of 11 publications including 470 subjects demonstrated a significant reduction of circulating oxidated LDL (ox-LDL) following bariatric surgery (SMD: -0.971, 95% CI: -1.317, -0.626, p < 0:001, I2: 89.43%) (Figure 2(a))
Summary
Obesity is a major risk factor for impaired glucose tolerance, insulin resistance, and type 2 diabetes mellitus, atherosclerotic cardiovascular disease (ASCVD) [1]. When LDL particles rich in cholesterol are present in plasma in larger quantities, they permeate through the altered endothelium into the subendothelial space entering the intima. Elevated plasma ox-LDL has been associated with atherogenesis and atherosclerotic cardiovascular disease (ASCVD) events. The aim of this meta-analysis was to investigate the impact of bariatric surgery on proatherogenic circulating ox-LDL levels in patients with severe obesity. A meta-regression analysis was conducted to explore the influence of, respectively, baseline and changes in body mass index (BMI), baseline ox-LDL, and postsurgery follow-up period with the estimated effect size of surgery on ox-LDL levels. The results of meta-regression did not show any significant association between the changes in ox-LDL after bariatric surgery and baseline BMI, duration of follow-up or baseline ox-LDL values. Bariatric surgery in patients who had severe obesity causes a decrease of circulating ox-LDL that was apparently dependent in BMI changes
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