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27/06/2024 - Press release

Gastric Bypass is a Better Alternative to Reduce Bad Cholesterol Levels in Obesity Surgery Candidates

• Gastric bypass is more effective than the other common approach, vertical sleeve gastrectomy, in reducing LDL cholesterol levels. This is a common comorbidity in patients undergoing this type of surgery and a primary agent causing atherosclerosis.

•  This is revealed in a study by the Bariatric Surgery Unit at Hospital del Mar, published in the journal Cardiovascular Diabetology.

• The study's authors argue that this fact should be considered when deciding which technique to use for each patient.

The presence of elevated LDL cholesterol, known as bad cholesterol, must be considered when deciding which surgical technique to use in obese candidates for bariatric surgery. This is the conclusion of a new study by the Bariatric Surgery Unit at Hospital del Mar, published in the journal Cardiovascular Diabetology. One in three people undergoing such an operation has high LDL cholesterol levels.

The recently published research, the BASALTO study (Bariatric surgery and LDL cholesterol), reveals that of the two most commonly used obesity surgery techniques worldwide, gastric bypass achieves a higher success rate in reducing LDL cholesterol compared to vertical sleeve gastrectomy. Dr. David Benaiges, head of the Endocrinology Section of the Endocrinology and Nutrition Service at Hospital del Mar and researcher at its research institute, points out that "the choice between one technique or another is a difficult process that has implications for that person's future for the rest of their life." Therefore, given the study's results, "having high LDL cholesterol before surgery must be a new criterion for the medical team when deciding which surgical technique to apply."

Two out of Three Patients Reduce Bad Cholesterol Levels.

This is a randomized study that included 36 patients with severe obesity and high LDL cholesterol, in which half were randomly assigned to gastric bypass and the other half to vertical sleeve gastrectomy. These types of studies, considered the highest scientific quality, are very rare in the field of obesity surgery, and none so far had focused on LDL cholesterol. One year after the operation, bad cholesterol normalized in 67% of cases in those who underwent gastric bypass, without medication. This percentage drops to 28% with the other technique.

Additionally, the percentage of the most harmful small and dense LDL cholesterol particles also decreased with bypass, whereas there was no improvement with vertical sleeve gastrectomy. However, both techniques were effective in weight loss and in reducing diabetes and hypertension, other comorbidities associated with obesity.

The study authors note that the fact that gastric bypass acts on both the stomach and the intestine is the differential factor compared to vertical sleeve gastrectomy, where only the stomach is operated on. Reducing the absorption capacity of the intestine minimizes the amount of cholesterol that reaches the blood, evidenced by a marked reduction in cholesterol absorption markers in patients undergoing bypass.

Dr. Benaiges, the lead author of the study, advocates "changing clinical practice and including LDL cholesterol levels in clinical practice guidelines." It should be considered that high concentrations of this type of cholesterol in the blood increase cardiovascular risk. Therefore, "with the bypass, you not only improve obesity but also protect the patient from a cardiovascular risk factor," he adds.

"The obesity epidemic is worsening cardiovascular health on a population scale. Among the available tools to combat this epidemic, bariatric surgery has been shown to be one of the most effective treatments not only for weight loss in severe obesity but also for cardiovascular benefits," explains Dr. Juan Pedro-Botet, head of the Endocrinology and Nutrition Service Section and study author. Despite the lack of data from randomized clinical trials on cardiovascular outcomes after bariatric surgery, cohort studies show that bariatric surgery is associated with lower all-cause mortality and a lower risk of severe cardiovascular events for patients with class III obesity. In this regard, "the main result of the BASALTO study confirms that gastric bypass quantitatively and qualitatively improves LDL cholesterol. This discovery is not trivial, considering that currently, bad cholesterol is not just a risk factor but a causal factor of atherosclerosis," adds Dr. Pedro-Botet.

Researchers from the Cardiovascular Risk and Nutrition Research Group and the Applied Metabolomics Research Group of the Hospital del Mar Research Institute, as well as the CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), the CIBER in Epidemiology and Public Health (CIBERESP), and the Consorci Sanitari de l'Alt Penedès Garraf participated in the work.

Reference Article

Benaiges, D., Goday, A., Casajoana, A. et al. Short-term effects of gastric bypass versus sleeve gastrectomy on high LDL cholesterol: The BASALTO randomized clinical trial. Cardiovasc Diabetol 23, 205 (2024). https://doi.org/10.1186/s12933-024-02296-x

More Information

Communication Department of Hospital del Mar. Tel. 932483537. dcollantes@hospitaldelmar.cat / comunicacio@hospitaldelmar.cat

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