Assessment of postprandial triglycerides in clinical practice: Validation in a general population and coronary heart disease patients

作者:Perez Martinez Pablo*; Alcala Diaz Juan F; Kabagambe Edmon K; Garcia Rios Antonio; Tsai Michael Y; Delgado Lista Javier; Kolovou Genovefa; Straka Robert J; Gomez Delgado Francisco; Hopkins Paul N; Marin Carmen; Borecki Ingrid; Yubero Serrano Elena M; Hixson James E; Camargo Antonio; Province Michael A; Lopez Moreno Javier; Rodriguez Cantalejo Fernando; Tinahones Francisco J; Mikhailidis Dimitri P; Perez Jimenez Francisco; Arnett Donna K; Ordovas Jose M
来源:Journal of Clinical Lipidology, 2016, 10(5): 1163-1171.
DOI:10.1016/j.jacl.2016.05.009

摘要

BACKGROUND: Previous studies have suggested that for clinical purposes, subjects with fasting triglycerides (TGs) between 89-180 mg/dl (1-2 mmol/l) would benefit from postprandial TGs testing. OBJECTIVE: To determine the postprandial TG response in 2 independent studies and validate who should benefit diagnostically from an oral-fat tolerance test (OFTT) in clinical practice. METHODS: A population of 1002 patients with coronary heart disease (CHD) from the CORDIOPREV clinical trial and 1115 white US subjects from the GOLDN study underwent OFTTs. Subjects were classified into 3 groups according to fasting cut points of TGs to predict the usefulness of OFTT: (1) TG < 89 mg/dl (<1 mmol/l); (2) TG, 89-180 mg/dl (1-2 mmol/l); and (3) TG > 180 mg/dl (>2 mmol/l). Postprandial TG concentration at any point > 220 mg/dl (>2.5 mmol/l) has been preestablished as an undesirable postprandial response. RESULTS: Of the total, 49% patients with CHD and 42% from the general population showed an undesirable response after the OFTT. The prevalence of undesirable postprandial TG in the CORDIOPREV clinical trial was 12.8, 50.3, and 89.7%, in group 1, 2, and 3, respectively (P <.001) and 11.2, 58.1, and 97.5% in group 1, 2, and 3, respectively (P <.001) in the GOLDN study. CONCLUSIONS: These two studies validate the predictive values reported in a previous consensus. Moreover, the findings of the CORDIOPREV and GOLDN studies show that an OFF! is useful to identify postprandial hyperlipidemia in subjects with fasting TG between 1-2 mmol/l (89-180 mg/dL), because approximately half of them have hidden postprandial hyperlipidemia, which may influence treatment. An OFTT does not provide additional information regarding postprandial hyperlipidemia in subjects with low TG (<1 mmolll, <89 mg/dL) or increased TG (>2 mmol/l, >180 mg/dl).

  • 出版日期2016-10