Journal of Lipid ResearchCardiovascular disease (CVD) is the leading cause of death and disability in the United States. Obesity is associated with hypertension, diabetes, elevated triglyceride (TG) levels, and decreased HDL-cholesterol (HDL-C) levels, all acknowledged as independent CVD risk factors by the AHA ( 1 ). Obesity, defi ned by body mass index (BMI) у 30 kg/m 2 , often coexists with the metabolic syndrome, which is associated with increased CVD risk. High BMI has been associated with increased risk for the development of coronary, cerebral, and peripheral vascular disease; however, due to the coexistence of multiple risk factors, the quantitative assessment of CVD risk exclusively associated with obesity is complicated.Bariatric surgery is an effective intervention to achieve long-term marked weight reduction in patients with morbid obesity ( 2, 3 ). It has recently been published that calculated 10 year CVD risk (based on the Framingham equation) in morbidly obese subjects decreased by 1.3% 12 months after laparoscopic Roux-en-Y gastric bypass (RYGBP) surgery ( 4 ) and that substantial weight loss, following RYGBP surgery,
Abstract Plasma lipoproteins and glucose homeostasis were evaluated after marked weight loss before and over 12 months following Roux-en-Y gastric-bypass (RYGBP) surgery in 19 morbidly obese women. Standard lipids, remnant-lipoprotein cholesterol (RLP-C); HDL-triglyceride (TG); apolipoproteins (apo) A-I, A-II, E, and A-I-containing HDL subpopulations; lecithin-cholesterol acyltransferase (LCAT)and cholesteryl ester transfer protein ( CETP) mass and activity; plasma glucose and insulin levels were measured before and at 1, 3, 6, and 12 months after GBP surgery. Baseline concentrations of TG, RLP-C, glucose, and insulin were signifi cantly higher in obese than in normal-weight, age-matched women, whereas HDL cholesterol (HDL-C), apoA-I, apoA-II, ␣ -1 and ␣ -2 levels were signifi cantly lower. Over 1 year, signifi cant decreases of body mass index, glucose, insulin, TG, RLP-C, HDL-TG, and pre  -1 levels were observed with signifi cant increases of HDL-C and ␣ -1 levels (all P < 0.05). Changes of fat mass were correlated with those of LDL cholesterol ( P = 0.018) and LCAT mass ( P = 0.011), but not with CETP mass ( P = 0.265). Changes of fasting plasma glucose concentrations were inversely correlated with those of CETP mass ( P = 0.005) and ␣ -1 level ( P = 0.004). Changes of fasting plasma insulin concentrations were positively correlated with those of LCAT mass ( P = 0.043) and inversely with changes of ␣ -1 ( P = 0.03) and ␣ -2 ( P = 0.05) concentrations. These results demonstrate benefi cial changes in HDL remodeling following substantial weight loss induced by RYGBP surgery and that these changes are associated with improvement of glucose homeostasis in these patients. -Asztalos, B.