Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Biomed Res Int. 2022 Aug 17;2022:8435133. doi: 10.1155/2022/8435133. eCollection 2022.
Obesity, especially severe obesity, is associated with a higher risk of atherosclerotic cardiovascular disease (ASCVD) morbidity and mortality. Bariatric surgery is a durable and effective weight loss therapy for patients with severe obesity and weight-related comorbidities. Elevated plasma levels of lipoprotein (a) (Lp(a)) are causally associated with ASCVD. The aim of this meta-analysis was to analyze whether bariatric surgery is associated with Lp(a) concentrations.
A literature search in PubMed, Scopus, Embase, and Web of Science was performed from inception to May 1st, 2021. A random-effects model and the generic inverse variance weighting method were used to compensate for the heterogeneity of studies in terms of study design, treatment duration, and the characteristics of the studied populations. A random-effects metaregression model was used to explore the association with an estimated effect size. Evaluation of funnel plot, Begg's rank correlation, and Egger's weighted regression tests were used to assess the presence of publication bias in the meta-analysis.
Meta-analysis of 13 studies including 1551 patients showed a significant decrease of circulating Lp(a) after bariatric surgery (SMD: -0.438, 95% CI: -0.702, -0.174, < 0.001, : 94.05%). The results of the metaregression did not indicate any significant association between the changes in Lp(a) and duration of follow-up after surgery, reduction in body mass index, or baseline Lp(a) concentration. The reduction in circulating Lp(a) was robust in the leave-one-out sensitivity analysis.
Bariatric surgery significantly decreases circulating Lp(a) concentrations. This decrease may have a positive effect on ASCVD in obese patients.
肥胖症，尤其是重度肥胖症，与动脉粥样硬化性心血管疾病（ASCVD）发病率和死亡率的增加相关。减重手术是治疗重度肥胖症和肥胖相关合并症患者的一种持久且有效的减肥疗法。脂蛋白（a）（Lp(a)）的血浆水平升高与 ASCVD 有因果关系。本荟萃分析旨在分析减重手术是否与 Lp(a)浓度相关。
从开始到 2021 年 5 月 1 日，在 PubMed、Scopus、Embase 和 Web of Science 中进行了文献检索。使用随机效应模型和通用倒数方差加权法，根据研究设计、治疗持续时间和研究人群的特征，对研究之间的异质性进行补偿。使用随机效应荟萃回归模型来探索与估计效应大小的关联。使用漏斗图、贝格等级相关和埃格加权回归检验评估荟萃分析中是否存在发表偏倚。
荟萃分析了包括 1551 名患者的 13 项研究，结果表明减重手术后循环 Lp(a)水平显著降低（SMD：-0.438，95%CI：-0.702，-0.174，<0.001，I²=94.05%）。荟萃回归的结果表明，Lp(a)变化与手术后随访时间、体重指数降低或基线 Lp(a)浓度之间没有显著关联。在逐一剔除敏感性分析中，循环 Lp(a)的降低是稳健的。
减重手术显著降低循环 Lp(a)浓度。这种降低可能对肥胖患者的 ASCVD 有积极影响。
