Conclusions RYGB surgery reverses the dyslipidaemia of obesity .
These findings support the use of RYGB in the management of high cardiovascular risk lipid profiles in morbid obesity
Background Obesity-related dyslipidaemia comprises hypercholesterolaemia , hypertriglyceridaemia , low HDL-cholesterol and normal to raised LDL-cholesterol levels .
40 % of morbidly obese surgical patients have dyslipidaemia .
Roux-en-Y gastric bypass ( RYGB ) surgery has many beneficial metabolic effects , but the full impact on plasma lipids has not been clearly defined .
Extended-release niacin or ezetimibe and carotid intima-media thickness.
BACKGROUND Treatment added to statin monotherapy to further modify the lipid profile may include combination therapy to either raise the high-density lipoprotein ( HDL ) cholesterol level or further lower the low-density lipoprotein ( LDL ) cholesterol level . METHODS We enrolled patients who had coronary heart disease or a coronary heart disease risk equivalent , who were receiving long-term statin therapy , and in whom an LDL cholesterol level under 100 mg per deciliter ( 2.6 mmol per liter ) and an HDL cholesterol level under 50 mg per deciliter for men or 55 mg per deciliter for women ( 1.3 or 1.4 mmol per liter , respectively ) had been achieved . The patients were r and omly assigned to receive extended-release niacin ( target dose , 2000 mg per day ) or ezetimibe ( 10 mg per day ) . The primary end point was the between-group difference in the change from baseline in the mean common carotid intima-media thickness after 14 months . The trial was terminated early , on the basis of efficacy , according to a prespecified analysis conducted after 208 patients had completed the trial . RESULTS The mean HDL cholesterol level in the niacin group increased by 18.4 % over the 14-month study period , to 50 mg per deciliter ( P < 0.001 ) , and the mean LDL cholesterol level in the ezetimibe group decreased by 19.2 % , to 66 mg per deciliter ( 1.7 mmol per liter ) ( P < 0.001 ) . Niacin therapy significantly reduced LDL cholesterol and triglyceride levels ;  ezetimibe reduced the HDL cholesterol and triglyceride levels . As compared with ezetimibe , niacin had greater efficacy regarding the change in mean carotid intima-media thickness over 14 months ( P = 0.003 ) , leading to significant reduction of both mean ( P = 0.001 ) and maximal carotid intima-media thickness ( P < or = 0.001 for all comparisons ) . Paradoxically , greater reductions in the LDL cholesterol level in association with ezetimibe were significantly associated with an increase in the carotid intima-media thickness ( R = -0.31 , P < 0.001 ) . The incidence of major cardiovascular events was lower in the niacin group than in the ezetimibe group ( 1 % vs. 5 % , P = 0.04 by the chi-square test ) . CONCLUSIONS This comparative-effectiveness trial shows that the use of extended-release niacin causes a significant regression of carotid intima-media thickness when combined with a statin and that niacin is superior to ezetimibe . ( Clinical Trials.gov number , NCT00397657 .
Conclusions RYGB surgery reverses the dyslipidaemia of obesity .
These findings support the use of RYGB in the management of high cardiovascular risk lipid profiles in morbid obesity
Background Obesity-related dyslipidaemia comprises hypercholesterolaemia , hypertriglyceridaemia , low HDL-cholesterol and normal to raised LDL-cholesterol levels .
40 % of morbidly obese surgical patients have dyslipidaemia .
Roux-en-Y gastric bypass ( RYGB ) surgery has many beneficial metabolic effects , but the full impact on plasma lipids has not been clearly defined .