Acute and Chronic Impact of Bariatric Surgery on Plasma LDL Cholesterol and PCSK9 Levels in Patients With Severe Obesity

• Published in: The journal of clinical endocrinology and metabolism 2017-11, Vol.102 (11), p.4023-4030
• Main Authors: Boyer, Marjorie, Piché, Marie-Eve, Auclair, Audrey, Grenier-Larouche, Thomas, Biertho, Laurent, Marceau, Simon, Hould, Frédéric-Simon, Biron, Simon, Lebel, Stéfane, Lescelleur, Odette, Julien, François, Martin, Julie, Tchernof, André, Carpentier, André C, Poirier, Paul, Arsenault, Benoit J
• Format: Article
• Language: English
• Subjects: Adult; Bariatric Surgery - adverse effects; Bariatric Surgery - rehabilitation; Body weight loss; Caloric Restriction; Case-Control Studies; Cholesterol; Cholesterol, LDL - blood; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diet therapy; Diabetes Mellitus, Type 2 - surgery; Dietary restrictions; Female; Gastrointestinal surgery; Humans; Kexin; Lipid metabolism; Low density lipoprotein; Male; Middle Aged; Obesity; Obesity, Morbid - blood; Obesity, Morbid - complications; Obesity, Morbid - diet therapy; Obesity, Morbid - surgery; Proprotein Convertase 9 - blood; Proprotein convertases; Subtilisin; Surgery; Time Factors; Weight control
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2017-00699

Abstract Context Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator of low-density lipoprotein cholesterol (LDL-C) concentrations. In patients with severe obesity, biliopancreatic diversion with duodenal switch (BPD-DS) surgery induces substantial weight loss and influences lipoprotein metabolism. The effect of BPD-DS on PCSK9 levels is unknown. Objectives To determine the acute and chronic impact of BPD-DS on PCSK9 levels and whether the acute impact of BPD-DS could be explained by BPD-DS–associated caloric restriction (CR). Design, Settings, and Participants PCSK9 levels were measured in 20 men and 49 women (age, 41.5 ± 11.1 years) with severe obesity before, 24 hours, 5 days, and 6 and 12 months after BPD-DS and in a comparable control group (n = 31) at baseline and at 6 and 12 months. PCSK9 levels were also measured during 3-day CR in patients (n = 7) with severe obesity and type 2 diabetes. Results PCSK9 levels increased 13.4% after 24 hours (248.7 ± 64.8 to 269.7 ± 63.8 ng/mL; P = 0,02) and decreased 9.5% at 12 months compared with baseline (217.6 ± 43.0 ng/mL; P < 0,0001). LDL-C levels decreased 36.2% after 24 hours (2.6 ± 0.7 to 1.7 ± 0.6 mmol/L; P < 0.0001) and 30% at 12 months compared with baseline (1.7 ± 0.5 mmol/L; P < 0.0001). Compared with baseline levels, PCSK9 levels were lower at day 2 but not at day 1 or 3 after CR. Conclusion BPD-DS is associated with acute increases in PCSK9 levels that do not appear to be explained by CR but may be due to an acute response following surgery. BPD-DS induces chronic reductions in both PCSK9 and LDL-C levels. Study results suggest that bariatric surgery decreased plasma PCSK9 and LDL-C levels in patients with severe obesity. Caloric restriction also decreased PCSK9 levels.