Improvements in cholesterol efflux capacity of HDL and adiponectin contribute to mitigation in cardiovascular disease risk after bariatric surgery in a cohort with morbid obesity

Abstract

Background Bariatric surgery can alleviate cardiovascular risk via effects on cardiovascular disease (CVD) risk factors such as diabetes mellitus, hypertension, and dyslipidemia. Our study aimed to assess the cholesterol efflux capacity (CEC) of HDL as a negative risk factor for CVD in individuals with obesity and identify the factors associated with improvement in CEC 3 months following bariatric surgery. Methods We recruited 40 control individuals (mean BMI of 22.2 kg/m2) and 56 obese individuals (mean BMI of 45.9 kg/m2). The biochemical parameters, inflammatory status and CEC of HDL was measured for the obese individuals before bariatric surgery and at 3 months after surgery. The CEC was measured using a cell-based cholesterol efflux system of BODIPY-cholesterol-labelled THP-1 macrophages. Results A significant reduction in BMI (− 17%, p < 0.001), resolution of insulin sensitivity (HOMA2-IR = − 23.4%, p = 0.002; Adipo IR = − 16%, p = 0.009) and inflammation [log resistin = − 6%, p = 0.07] were observed 3 months post-surgery. CEC significantly improved 3 months after surgery [Pre: 0.91 ± 0.13; Post: 1.02 ± 0.16; p = 0.001] despite a decrease in HDL-C levels. The change in CEC correlated with the change in apo A-I (r = 0.39, p = 0.02) and adiponectin levels (r = 0.35, p = 0.03). Conclusion The results suggest that improvements in CEC, through improvement in adipose tissue health in terms of adipokine secretion and insulin sensitivity could be an important pathway in modulating obesity-related CVD risk.

The Role of Adiponectin in the Resolution of Male-Obesity-Associated Secondary Hypogonadism after Metabolic Surgery and Its Impact on Cardiovascular Risk

“…On the other hand, there are consistent published data showing that the increase in circulating APN after metabolic surgery induces beneficial metabolic changes, such as the reduction in insulin resistance, the resolution of type 2 DM [ 23 , 25 , 37 , 38 ], improvements in lipid profiles, and the reduction of inflammatory markers [ 39 , 40 , 41 , 42 ]. In agreement, a recent meta-analysis found an inverse association between APN levels and cIMT [ 29 ], and, in the Northern Manhattan Study that included a cohort of 1522 individuals, low APN was associated with increased cIMT, supporting the protective role for APN in atherosclerosis [ 27 ].…”

High-Density Lipoprotein Alterations in Type 2 Diabetes and Obesity

“…Finally, bariatric surgery appears to be beneficial for HDL functions. It improves HDL-mediated CEC in obese [ 198 , 208 , 209 ] and T2DM patients [ 210 ], increases antioxidative HDL function in obese individuals [ 211 ], stimulates HDL-induced NO production by endothelial cells [ 198 ], and restores HDL-mediated inhibition of endothelial cell apoptosis and inflammation [ 198 ].…”

A Potential Interplay between HDLs and Adiponectin in Promoting Endothelial Dysfunction in Obesity

“…Marsche et al observed in adult obese subjects a positive correlation between reduced plasma adiponectin and cholesterol efflux capacity of HDLs, independently of sex, BMI, fat distribution, blood pressure, and kidney and liver functions [ 111 ]. A recent study [ 112 ] shows that the levels of HDL-C significantly improve in obese individuals after bariatric surgery, which determines a rapid reduction of AT and consequently an increase of adiponectin production. In particular, the data show that bariatric surgery promotes an improvement of ApoA-I and adiponectin levels in parallel with an amelioration of cholesterol efflux capacity.…”

“…In particular, the data show that bariatric surgery promotes an improvement of ApoA-I and adiponectin levels in parallel with an amelioration of cholesterol efflux capacity. For this reason, the increase in adiponectin production, as a crucial modulator of ApoA-I synthesis and hence of HDLs function, may represent a mechanism for decreasing cardiovascular risk associated with obesity [ 112 ]. HDL-C itself is considered a positive factor for endothelial health and is inversely related to CVD risk.…”