{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T11:47:47Z","timestamp":1793792867280,"version":"4.6.1"},"reference-count":28,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T00:00:00Z","timestamp":1633910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>Patients undergoing cardiac surgery are at increased cardiovascular risk, which includes altered lipid status. However, data on the effect of cardiac surgery and cardiopulmonary bypass (CPB) on plasma levels of key lipids are scarce. We investigated potential effects of CPB on plasma lipid levels and associations with early postoperative clinical outcomes. This is a prospective bio-bank study of patients undergoing elective cardiac surgery at our center January to December 2019. The follow-up period was 1 year after surgery. Blood sampling was performed before induction of general anesthesia, upon weaning from cardiopulmonary bypass (CPB), and on the first day after surgery. Clinical end points included the incidence of postoperative stroke, myocardial infarction, and death of any cause at 30 days after surgery as well as 1-year all-cause mortality. A total of 192 cardiac surgery patients (75% male, median age 67.0 years (interquartile range 60.0\u201373.0), median BMI 26.1 kg\/m2 (23.7\u201330.4)) were included. A significant intraoperative decrease in plasma levels compared with preoperative levels (all p &lt; 0.0001) was observed for total cholesterol (TC) (Cliff\u2019s delta d: 0.75 (0.68\u20130.82; 95% CI)), LDL-Cholesterol (LDL-C) (d: 0.66 (0.57\u20130.73)) and HDL-Cholesterol (HDL-C) (d: 0.72 (0.64\u20130.79)). At 24h after surgery, the plasma levels of LDL-C (d: 0.73 (0.650.79)) and TC (d: 0.77 (0.69\u20130.82)) continued to decrease compared to preoperative levels, while the plasma levels of HDL-C (d: 0.46 (0.36\u20130.55)) and TG (d: 0.40 (0.29\u20130.50)) rebounded, but all remained below the preoperative levels (p &lt; 0.001). Mortality at 30 days was 1.0% (N = 2\/192), and 1-year mortality was 3.8% (N = 7\/186). Postoperative myocardial infarction occurred in 3.1% of patients (N = 6\/192) and postoperative stroke in 5.8% (N = 11\/190). Adjusting for age, sex, BMI, and statin therapy, we noted a protective effect of postoperative occurrence of stroke for pre-to-post-operative changes in TC (adjusted odds ratio (OR) 0.29 (0.07\u20130.90), p = 0.047), in LDL-C (aOR 0.19 (0.03\u20130.88), p = 0.045), and in HDL-C (aOR 0.01 (0.00\u20130.78), p = 0.039). No associations were observed between lipid levels and 1-year mortality. In conclusion, cardiac surgery induces a significant sudden drop in levels of key plasma lipids. This effect was pronounced during the operation, and levels remained significantly lowered at 24 h after surgery. The intraoperative drops in LDL-C, TC, and HDL-C were associated with a protective effect against occurrence of postoperative stroke in adjusted models. We demonstrate that the changes in key plasma lipid levels during surgery are strongly correlated, which makes attributing the impact of each lipid to the clinical end points, such as postoperative stroke, a challenging task. Large-scale analyses should investigate additional clinical outcome measures.<\/jats:p>","DOI":"10.3390\/cells10102717","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T09:16:42Z","timestamp":1633943802000},"page":"2717","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Effect of Perioperative Lipid Status on Clinical Outcomes after Cardiac Surgery"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6298-7985","authenticated-orcid":false,"given":"Maks","family":"Mihalj","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"},{"name":"Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Philipp","family":"Heinisch","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"},{"name":"Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"},{"name":"Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen, 80636 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8081-0684","authenticated-orcid":false,"given":"Markus","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9162-5724","authenticated-orcid":false,"given":"Joerg C.","family":"Schefold","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Klinische Chemie und Laboratoriumsmedizin, Universit\u00e4tsmedizin Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4758-9716","authenticated-orcid":false,"given":"Michael","family":"Walter","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Klinische Chemie und Laboratoriumsmedizin, Universit\u00e4tsmedizin Rostock, 18057 Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Steinhagen-Thiessen","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Klinische Chemie und Laboratoriumsmedizin, Universit\u00e4tsmedizin Rostock, 18057 Rostock, Germany"},{"name":"Department of Endocrinology and Metabolic Medicine, Division of Lipid Metabolism, Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6881-0956","authenticated-orcid":false,"given":"Juerg","family":"Schmidli","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"St\u00fcber","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenz","family":"R\u00e4ber","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9049-2584","authenticated-orcid":false,"given":"Markus M.","family":"Luedi","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e526","DOI":"10.1161\/CIR.0000000000000659","article-title":"Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association","volume":"139","author":"Benjamin","year":"2019","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e018897","DOI":"10.1161\/JAHA.120.018897","article-title":"Lipid Management in Patients Presenting With Acute Coronary Syndromes: A Review","volume":"9","author":"Claessen","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk","volume":"41","author":"Mach","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1056\/NEJMoa1507750","article-title":"Perioperative Rosuvastatin in Cardiac Surgery","volume":"374","author":"Zheng","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3576","DOI":"10.1093\/eurheartj\/ehw377","article-title":"The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial","volume":"37","author":"Eisen","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3168","DOI":"10.1016\/j.jacc.2018.11.002","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"73","author":"Grundy","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/ejcts\/ezx314","article-title":"2017 EACTS Guidelines on perioperative medication in adult cardiac surgery","volume":"53","author":"Head","year":"2018","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s40140-020-00377-7","article-title":"Recommendations for Preoperative Assessment and Shared Decision-Making in Cardiac Surgery","volume":"10","author":"Mihalj","year":"2020","journal-title":"Curr. Anesthesiol. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jtcvs.2019.07.086","article-title":"Development of a risk score for early saphenous vein graft failure: An individual patient data meta-analysis","volume":"160","author":"Antonopoulos","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.hlc.2019.02.008","article-title":"Risk Factors and Outcomes in Redo Coronary Artery Bypass Grafting","volume":"29","author":"Gallo","year":"2020","journal-title":"Heart Lung Circ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1093\/ejcts\/ezt261","article-title":"Effect of lipid exposure on graft patency and clinical outcomes: Arteries and veins are different","volume":"45","author":"Zhu","year":"2014","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/j.1467-9868.2005.00503.x","article-title":"Regularization and variable selection via the elastic net","volume":"67","author":"Zou","year":"2005","journal-title":"J. R. Stat. Soc Ser. B (Stat. Methodol.)"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1007\/s00134-016-4358-8","article-title":"Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery: A randomized, placebo-controlled trial","volume":"42","author":"Park","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1248\/yakushi.127.173","article-title":"Effects of Propofol and Midazolam on Lipids, Glucose, and Plasma Osmolality during and in the Early Postoperative Period Following Coronary Artery Bypass Graft Surgery: A Randomized Trial","volume":"127","author":"Issever","year":"2007","journal-title":"Yakugaku Zasshi"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1056\/NEJMoa0808207","article-title":"Fluvastatin and perioperative events in patients undergoing vascular surgery","volume":"361","author":"Schouten","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.atherosclerosis.2020.05.005","article-title":"Lower levels of high-density lipoprotein cholesterol are associated with increased cardiovascular events in patients with acute coronary syndrome","volume":"303","author":"Nakazawa","year":"2020","journal-title":"Atherosclerosis"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.numecd.2020.10.014","article-title":"Lipid levels and the risk of hemorrhagic stroke: A dose-response meta-analysis","volume":"31","author":"Jin","year":"2021","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Miura, T., Izawa, A., Motoki, H., Miyashita, Y., Kashima, Y., Ebisawa, S., Tomita, T., Koyama, J., and Ikeda, U. (2015). Clinical Impact of Rapid Reduction of Low-Density Lipoprotein Cholesterol Level on Long-Term Outcome of Acute Myocardial Infarction in the Statin Era: Subanalysis of the ALPS-AMI Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0127835"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1001\/jama.2018.2525","article-title":"Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering: A Systematic Review and Meta-analysis","volume":"319","author":"Navarese","year":"2018","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3286","DOI":"10.1111\/jocs.15014","article-title":"Impact of lipid levels and high-intensity statins on vein graft patency after CABG: Midterm results of the ACTIVE trial","volume":"35","author":"Kulik","year":"2020","journal-title":"J. Card. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.atherosclerosis.2019.12.006","article-title":"Effects of intensive lipid-lowering therapy on mortality after coronary bypass surgery: A meta-analysis of 7 randomised trials","volume":"293","author":"Alkhalil","year":"2020","journal-title":"Atherosclerosis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/j.jacc.2020.09.536","article-title":"Influence of LDL-Cholesterol Lowering on Cardiovascular Outcomes in Patients with Diabetes Mellitus Undergoing Coronary Revascularization","volume":"76","author":"Farkouh","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1590\/1806-9282.67.02.20200548","article-title":"Lower LDL-cholesterol levels associated with increased inflammatory burden in patients with acute ST-segment elevation myocardial infarction","volume":"67","author":"Yaman","year":"2021","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1067\/mva.2002.128301","article-title":"Serum lipids act as inverse acute phase reactants and are falsely low in patients with critical limb ischemia","volume":"36","author":"Bismuth","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1194\/jlr.E005454","article-title":"The acute phase response inhibits reverse cholesterol transport","volume":"51","author":"Feingold","year":"2010","journal-title":"J. Lipid Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.3389\/fimmu.2018.02160","article-title":"Inflammation, a Double-Edge Sword for Cancer and Other Age-Related Diseases","volume":"9","author":"Gupta","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s41584-018-0109-2","article-title":"Anti-inflammatory and immune-regulatory cytokines in rheumatoid arthritis","volume":"15","author":"Chen","year":"2019","journal-title":"Nat. Rev. Rheumatol."}],"container-title":["Cells"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-4409\/10\/10\/2717\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:11:35Z","timestamp":1760166695000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-4409\/10\/10\/2717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,11]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["cells10102717"],"URL":"https:\/\/doi.org\/10.3390\/cells10102717","relation":{},"ISSN":["2073-4409"],"issn-type":[{"value":"2073-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,11]]}}}