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Surgical management of dyslipidemia: clinical and experimental evidence
M H Moghadasian1, J J Frohlich, M Saleem
1Department of Pathology, University of British Columbia, Vancouver, Canada. mhmoghad@unixg.ubc.ca
Insights
Partial ileal bypass (PIB) surgery effectively lowers cholesterol levels, reducing risks associated with coronary artery disease (CAD). This surgical approach shows promise for managing dyslipidemia and improving cardiovascular health outcomes.
Area of Science:
- Cardiovascular Surgery
- Metabolic Disorders
- Medical Review
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality, with dyslipidemia as a primary contributor.
- Various interventions, including diet, medication, and surgery, aim to reduce plasma cholesterol levels to mitigate CAD risks.
Purpose of the Study:
- To review the evidence on the cholesterol-lowering efficacy and safety of the partial ileal bypass (PIB) procedure.
- To assess the impact of PIB on lipid profiles and related cardiovascular markers in human and animal studies.
Main Methods:
- Review of human and animal studies evaluating the partial ileal bypass (PIB) procedure.
- Analysis of data from the Program on the Surgical Control of the Hyperlipidemias (POSCH) study involving 838 myocardial infarction patients.
Main Results:
- PIB surgery significantly reduced total cholesterol (TC) by up to 27% and low-density lipoprotein (LDL) cholesterol by up to 42%.
- The procedure increased high-density lipoprotein (HDL) cholesterol by up to 8%, improved HDL/TC and HDL/LDL ratios, and altered apolipoprotein levels (decreased apo B100, increased apo AI).
- PIB is effective for managing heterozygous familial hypercholesterolemia and sitosterolemia.
Conclusions:
- Partial ileal bypass (PIB) surgery is a highly effective method for lowering plasma cholesterol, particularly in specific hyperlipidemic conditions.
- While generally safe, further extensive research is needed to evaluate long-term effects on organ function and atherosclerotic lesion progression.
- Careful consideration of PIB indications is crucial, especially with the availability of alternative dyslipidemia treatments.
Abstract:
Coronary artery disease (CAD) is still a major cause of mortality in developed countries, and dyslipidemia is one of its major causes. In an attempt to reduce both mortality and morbidity from CAD, several dietary, pharmacological, and surgical approaches have been used to reduce plasma cholesterol levels. In this brief review, we summarize the evidence for cholesterol-lowering effects and safety of partial ileal bypass (PIB) procedure in both human and animal studies. The results of the Program on the Surgical Control of the Hyperlipidemias (POSCH), which involved a total of 838 subjects with myocardial infarction, are promising. A 5-year follow-up of this study revealed significant reductions of up to 27% in total cholesterol (TC) and up to 42% in low-density lipoprotein (LDL) cholesterol levels along with an increase of up to 8% in high-density lipoprotein (HDL) cholesterol levels as compared to controls. These changes were associated with other benefits such as increased HDL/TC and HDL/LDL ratios, and a significant decrease in apolipoprotein (apo) B100 and increase in apo AI levels. Similar results were also demonstrated by other studies. PIB surgery is one of the most effective methods for reduction of plasma cholesterol levels, particularly in patients with heterozygous familial hypercholesterolemia. This procedure is also applicable to treatment of sitosterolemia, a rare genetic disorder in which the absorption of plant sterols is abnormally high. Although no major complications of this method have been reported, more extensive studies are required to evaluate its long-term effects on renal and hepatic function. Similarly, long-term impact of this procedure on progression/regression of atherosclerotic lesions must be documented. Finally, indications for this procedure should be carefully considered, particularly in view of availability of other treatments of dyslipidemia.