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. 2022 Sep 1;5(9):e2233843.
doi: 10.1001/jamanetworkopen.2022.33843.

Remission and Relapse of Dyslipidemia After Vertical Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass in a Racially and Ethnically Diverse Population

Karen J Coleman  1 , Anirban Basu  2 , Lee J Barton  1 , Heidi Fischer  1 , David E Arterburn  3 , Douglas Barthold  4 , Anita Courcoulas  5 , Cecelia L Crawford  6 , Benjamin B Kim  7 , Peter N Fedorka  8 , Edward C Mun  7 , Sameer B Murali  9 , Kristi Reynolds  1 , Robert E Zane  7 , Sami Alskaf  10
Affiliations

Remission and Relapse of Dyslipidemia After Vertical Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass in a Racially and Ethnically Diverse Population

Karen J Coleman et al. JAMA Netw Open. .

Abstract

Importance: The comparative effectiveness of the most common operations in the long-term management of dyslipidemia is not clear.

Objective: To compare 4-year outcomes associated with vertical sleeve gastrectomy (VSG) vs Roux-en-Y gastric bypass (RYGB) for remission and relapse of dyslipidemia.

Design, setting, and participants: This retrospective comparative effectiveness study was conducted from January 1, 2009, to December 31, 2016, with follow-up until December 31, 2018. Participants included patients with dyslipidemia at the time of surgery who underwent VSG (4142 patients) or RYGB (2853 patients). Patients were part of a large integrated health care system in Southern California. Analysis was conducted from January 1, 2018, to December 31, 2021.

Exposures: RYGB and VSG.

Main outcomes and measures: Dyslipidemia remission and relapse were assessed in each year of follow-up for as long as 4 years after surgery.

Results: A total of 8265 patients were included, with a mean (SD) age of 46 (11) years; 6591 (79.8%) were women, 3545 (42.9%) were Hispanic, 1468 (17.8%) were non-Hispanic Black, 2985 (36.1%) were non-Hispanic White, 267 (3.2%) were of other non-Hispanic race, and the mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 44 (7) at the time of surgery. Dyslipidemia outcomes at 4 years were ascertained for 2168 patients (75.9%) undergoing RYGB and 3999 (73.9%) undergoing VSG. Remission was significantly higher for those who underwent RYGB (824 [38.0%]) compared with VSG (1120 [28.0%]) (difference in the probability of remission, 0.10; 95% CI, 0.01-0.19), with no differences in relapse (455 [21.0%] vs 960 [24.0%]). Without accounting for relapse, remission of dyslipidemia after 4 years was 58.9% (1279) for those who underwent RYGB and 51.9% (2079) for those who underwent VSG. Four-year differences between operations were most pronounced for patients 65 years or older (0.39; 95% CI, 0.27-0.51), those with cardiovascular disease (0.43; 95% CI, 0.24-0.62), or non-Hispanic Black patients (0.13; 95% CI, 0.01-0.25) and White patients (0.13; 95% CI, 0.03-0.22).

Conclusions and relevance: In this large, racially and ethnically diverse cohort of patients who underwent bariatric and metabolic surgery in clinical practices, RYGB was associated with higher rates of dyslipidemia remission after 4 years compared with VSG. However, almost one-quarter of all patients experienced relapse, suggesting that patients should be monitored closely throughout their postoperative course to maximize the benefits of these operations for treatment of dyslipidemia.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Coleman reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Basu reported receiving consulting fees from Salutis Consulting LLC outside the submitted work. Dr Arterburn reported receiving grants from the NIH during the conduct of the study, having a contract with Sharecare, Inc, and receiving grants from the Patient-Centered Outcomes Research Institute outside the submitted work, and receiving support for personal travel to conferences from the World Congress for Interventional Therapy for Type 2 Diabetes and the International Federation for the Surgery of Obesity and Metabolic Disorders Latin America Chapter. Dr Reynolds reported receiving grants from the NIH during the conduct of the study and grants from Merck & Co, Vital Strategies, Novartis, and CSL Behring, LLC outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram for Selection of Patients With Dyslipidemia in the Effectiveness of Gastric Bypass vs Gastric Sleeve for Cardiovascular Disease (ENGAGE CVD) Cohort Study
IV indicates instrumental variable; RYGB, Roux-en-Y gastric bypass; VSG, vertical sleeve gastrectomy.
Figure 2.
Figure 2.. Dyslipidemia Status for Patients Following Vertical Sleeve Gastrectomy (VSG) or Roux-en-Y Gastric Bypass (RYGB) in the Effectiveness of Gastric Bypass vs Gastric Sleeve for Cardiovascular Disease Cohort Study
An original status refers to patients who continued to have dyslipidemia throughout the follow-up period and never experienced remission (or relapse). Data are presented as adjusted probabilities in panels A and B and the average difference in adjusted probabilities between RYGB and VSG with 95% CIs (blue shading) in panels C, D, and E. 95% CIs that did not overlap 0 were considered statistically significant.
Figure 3.
Figure 3.. Lipid Levels Between Vertical Patients Undergoing Sleeve Gastrectomy (VSG) and Roux-en-Y Gastric Bypass (RYGB) in the Effectiveness of Gastric Bypass vs Gastric Sleeve for Cardiovascular Disease Cohort Study
Data are presented at baseline and in each year of follow-up for unadjusted mean levels (panels A-D) and the average difference in adjusted mean values between RYGB and VSG with 95% CIs (panel E). 95% CIs that did not overlap 0 were considered statistically significant. To convert high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol to millimoles per liter, multiply by 0.0259; to convert triglycerides to millimoles per liter, multiply by 0.0113.
See this image and copyright information in PMC

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