Cor Vasa . X:X | DOI: 10.33678/cor.2025.020

Cardiovascular Risk Factors and DXA-Assessed Body Composition Changes After Laparoscopic Sleeve Gastrectomy: A One-Year Retrospective Study

Matej Pekař^a,b,c, Pavol Holéczy^d,e, Jitka Macháčková^g,h,ch,i, Aleš Foltys^e,i,, Zdeněk Švagera^j, Marek Bužga^a,f

^a Department of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Ostrava, the Czech Republic

^b Complex cardiovascular center, Hospital AGEL Třinec-Podlesí, Třinec, the Czech Republic

^c Department of Physiology, Faculty of Medicine, Masaryk University, Brno, the Czech Republic

^d Department of Surgery, Hospital AGEL Ostrava-Vítkovice, Ostrava, the Czech Republic

^e Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, the Czech Republic

^f Centre for Nutrition Research and Obesity, Faculty of Medicine, University of Ostrava, Ostrava, the Czech Republic

^g Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, the Czech Republic

^h Department of Internal Medicine and Cardiology, University Hospital Ostrava, Ostrava, the Czech Republic

^ch Department of Clinic Subjects, Faculty of Medicine, University of Ostrava, Ostrava, the Czech Republic

ⁱ Department of Surgery, University Hospital, Ostrava, Ostrava, the Czech Republic

^j Department of Clinical Biochemistry, Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, the Czech Republic

Background: While laparoscopic sleeve gastrectomy (LSG) is known to reduce weight, its impact on cardiovascular risk profile through changes in body composition remains unclear.

Methods: This retrospective study evaluated 98 patients who underwent LSG, analyzing body composition via dual-energy X-ray absorptiometry (DXA) and cardiovascular risk parameters at baseline and 12 months post-surgery. Changes in weight, fat mass, lean mass, atherogenic lipid profile, and glucose metabolism were assessed, along with their interrelationships.

Results: Significant reductions were observed in total body weight, fat mass, and lean mass at 12 months post-surgery (all p <0.001). Metabolic parameters showed marked improvements, with significant decreases in fasting glucose, HbA1c, and triglycerides, alongside an increase in HDL cholesterol (all p <0.001). The LDL/HDL ratio improved from median (IQR) 2.79 (1.59) to 2.20 (0.91) (p <0.001). The atherogenic index of plasma decreased from 0.23 (0.30) to –0.10 (0.29) (p <0.001), representing a shift from increased to low cardiovascular risk. A moderate negative correlation was identified between changes in lean mass and HDL cholesterol (r = –0.331, p <0.001), while weak but significant correlations were found between changes in waist-to-hip ratio and glycemic parameters.

Conclusions: LSG results in significant improvements in cardiovascular risk profile at one year post-surgery, with favorable changes in atherogenic lipid parameters and body composition. The novel correlation between lean mass preservation and HDL cholesterol suggests that maintaining muscle mass might be crucial for optimizing cardiovascular benefits following bariatric surgery.

Keywords: sleeve gastrectomy; body composition; DXA; cardiovascular risk; atherogenic dyslipidemia; HDL cholesterol

Received: January 9, 2025; Revised: January 9, 2025; Accepted: February 2, 2025; Prepublished online: September 26, 2025