Statin use lowers after gastric bypass surgery

Long-term data from a retrospective cohort study showed that hyperlipidemic obese patients had more than a 90% reduction in their need of lipid-lowering therapy following laparoscopic gastric-bypass surgery, MedPage Today reported.

One-fourth of patients were on lipid-lowering medication before surgery. Six months after surgery, only 2% of patients needed medication to control cholesterol. At 6 years, none of the patients was on lipid-lowering therapy.

The findings raise questions about the potential of bariatric surgery in lipid management, said Isaac Samuel, MD, associate professor in the Department of Surgery at the University of Iowa, at the American Society of Metabolic and Bariatric Surgery meeting in Las Vegas in June.

“Is Roux-en-Y gastric bypass better than lipid-lowering medications in the treatment of hyperlipidemia in the morbidly obese?” Dr. Samuel asked. “Could there be a place for the Roux-en-Y gastric bypass in the management of hyperlipidemia in patients with a body mass index less than 35?”

The findings came from a retrospective analysis of medical records on 248 patients who underwent Roux-en-Y gastric-bypass surgery from March 2000 to June 2005. Of those patients, 94 were taking lipid-lowering medication at the time of surgery. They had a mean age of 39, mean body weight of 308 pounds, and mean body mass index (BMI) of 50. Females represented approximately 80% of the cohort.

Following surgery, the mean BMI in the 248 patients decreased to approximately 30 after 12 months, and it was between 35 and 40 after 6 years of follow-up. Loss of excess weight averaged 60% at 12 months and approximately 40% at 6 years.

Fasting total cholesterol averaged 220 mg/dL before surgery, declined to 175 mg/dL 1 year after surgery, and averaged 160 mg/dL 6 years after surgery. Triglycerides and LDL cholesterol followed a similar pattern of decline. Mean HDL cholesterol increased from 51 mg/dL before surgery to 57 mg/dL after 6 years.

Before surgery, 24% of the patients were on lipid-lowering medication, declining to 2.1% at 6 months, rising to 3.2% at 12 months, and 6.4% at 3 years. No patient was taking lipid-lowering drugs at 5 or 6 years.

Dr. Samuel called for prospective evaluation of the impact of gastric bypass surgery on dyslipidemia.

The study was published as an abstract and presented at a conference.