Journal of Multidisciplinary Healthcare (Oct 2024)
Examination of Postoperative Changes in Lipid Profile and Glycemic Markers After Coronary Artery Bypass Graft, Percutaneous Intervention Vs Aortic Valve Replacement Demonstrated a Shift in Risk Factors for Coronary Artery Disease
Abstract
Kelley Flesher,1 Amal Mathew,2 Yuliya Borovskiy,3,4 Krzysztof Laudanski5 1Department of Neurology, Division of Neurocritical Care, University of Pennsylvania, Philadelphia, PA, USA; 2School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA; 3Corporate Informational Service, Penn Medicine, Philadelphia, PA, USA; 4Data Analytics Core, Penn Medicine, Philadelphia, PA, USA; 5Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN, USACorrespondence: Krzysztof Laudanski, Department of Anesthesiology and Perioperative Care, Division of Critical Care Medicine, Mayo Clinic, 200 1st St, Rochester, MN, 55902, USA, Tel +1 (507) 255-5123, Email [email protected]: Surgery-related stress may affect the metabolome, leading to abnormal lipid profiles and ineffective glycemic control. Here, we gauge these changes as they may accelerate atherosclerosis, limiting the benefits of interventions aimed at improving coronary artery disease (CAD) progression.Patients and Methods: Electronic medical records were queried to identify patients undergoing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or aortic valve replacement (AVR). 7573 records denoted lipid profile (cholesterol, LDL, HDL, VLDL, triglycerides) and glucose metabolism impairment (HbA1c). Pre-procedure lipid and glucose laboratory values were compared with periods representing acute periprocedural inflammation (1– 3 months), resolution of acute inflammation (3– 6 months), convalescence (6– 12 months), and medium- (1– 2 years), and long-term periods (2– 5 years).Results: Baseline values differed between groups (AVR: Cholesterol↑↓, LDL↓↑, HDL↓, Triglycerides↑, HbA1c↓; CABG: Cholesterol↓, LDL↓, HDL↓, Triglycerides↓, HbA1c↓; PCI: Cholesterol↑↓, LDL↑↓, HDL↑↓, Triglycerides↓, HbA1c↓). Interestingly, total cholesterol and LDL had opposite trajectories after CABG vs AVR even five years after surgical procedure and the effects were moderate as denoted by d-Cohen statistics. HDL declined acutely after CABG and AVR but not after PCI. Triglycerides were elevated for 2 years after AVR but depressed after CABG and PCI. HbA1c remained depressed for up to 5 years after any studied procedure.Conclusion: Our data suggest surgical procedures result in prolonged lipid profile and glycemic metabolism disturbances, particularly after aortic valve replacement, indicating more aggressive post-surgical treatment of these metabolic abnormalities may be warranted.Keywords: cardiac surgery, inflammation, lipid profile, glycated hemoglobin
