Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Prevents Atherosclerosis Development in LDL Receptor Deficient Mice

INTRODUCTION: Bariatric surgeries improve cardiovascular health through modulation of plasma lipid profiles. Among these procedures, single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) yields marked metabolic benefits; however, its impact on atherosclerosis has not yet been defined. This study aimed to assess the impact of SADI-S on atherosclerosis development in a mouse model of atherosclerotic disease. METHODS: Low-density lipoprotein receptor–deficient (Ldlr−/−) male mice were fed a high-fat diet for 12 weeks and subsequently underwent either SADI-S or sham laparotomy. Mice were then transitioned to a cholesterol-enriched Western diet from 6 to 12 weeks post-surgery. Atherosclerotic burden was quantified histologically as the ratio of Oil Red O–positive plaque area to total aortic root surface. RESULTS: SADI-S induced a sustained 30% body weight loss compared to Sham mice. The introduction of a western diet led to a significant increase in plasma cholesterol and triglyceride levels in Sham mice, which was prevented following SADI-S. Plasma cholesterol and triglycerides were significantly lower after SADI-S compared with Sham 84 days after surgery. SADI-S was associated with a reduced surface area of Oil red O-stained aortic lesions in the aortic root compared to Sham mice (12.8 ± 1.4 vs. 19.9 ± 1.7%, p = 0.014). Surface of atherosclerotic lesions was correlated with plasma cholesterol 84 days after surgery (r = 0.74, p = 0.0056). CONCLUSION: SADI-S effectively prevented atherosclerosis in male Ldlr−/− mice. These results suggest the clinical significance of SADI-S in enhancing cardiovascular health within the context of obesity management.