Durable improvements in lipid profile and atherogenic indices more than a decade after laparoscopic sleeve gastrectomy

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Abstract
Long-term effects of laparoscopic sleeve gastrectomy (LSG) on lipid metabolism, particularly beyond 10 years, are not well defined. This study evaluated changes in standard lipid parameters and atherogenic indices more than 11 years after stand-alone LSG. This retrospective cohort study included adults who underwent primary stand-alone LSG between 2005 and 2009. Patients with revisional bariatric procedures or major gastrointestinal or appetite-related disorders were excluded. Lipid profiles were assessed preoperatively and at follow-up beyond 11 years. Primary outcomes were long-term changes in triglycerides, total cholesterol, LDL-C, HDL-C, and non-HDL-C. Secondary outcomes included changes in the atherogenic index of plasma, triglyceride/HDL-C ratio, Castelli risk indices I and II, atherogenic coefficient, and use of lipid-lowering medications. Multivariable linear regression was used to identify independent predictors of lipid change. Eighty-six patients (79.1%, female) were analyzed, with a mean follow-up of 13.4 ± 1.3 years. Mean total body weight loss (%TBWL) was 28.8 ± 12.5%. Triglyceride levels decreased from 130.7 ± 64.9 to 91.2 ± 36.8 mg/dL, HDL-C increased from 45.2 ± 9.5 to 62.6 ± 14.7 mg/dL, and non-HDL-C decreased from 151.9 ± 38.0 to 134.0 ± 27.4 mg/dL (all p < 0.001). Total cholesterol remained unchanged, while the reduction in LDL-C was no longer significant after adjustment for multiple comparisons. All five atherogenic indices showed significant improvement (p < 0.001). Greater %TBWL was independently associated with higher HDL-C and lower triglyceride levels at follow-up. More than a decade after stand-alone LSG, improvements in triglycerides, HDL-C, non-HDL-C, and atherogenic indices remain robust. However, these findings should be interpreted cautiously regarding cardiovascular and atherosclerotic risk.

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