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Postprandial Hypertriglyceridaemia Revisited in the Era of Non-Fasting Lipid Profile Testing: A 2019 Expert Panel Statement, Main Text

[ Vol. 17 , Issue. 5 ]

Author(s):

Genovefa D. Kolovou, Gerald F. Watts, Dimitri P. Mikhailidis, Pablo Pérez-Martínez, Samia Mora, Helen Bilianou, George Panotopoulos, Niki Katsiki, Teik C. Ooi, José Lopez-Miranda, Anne Tybjærg-Hansen, Nicholas Tentolouris and Børge G. Nordestgaard   Pages 498 - 514 ( 17 )

Abstract:


Residual vascular risk exists despite aggressive lowering of low density lipoprotein cholesterol (LDL-C). A contributor to this residual risk may be elevated fasting, or non-fasting, levels of triglyceride (TG)-rich lipoproteins. Therefore, there is a need to establish whether a standardised oral fat tolerance test (OFTT) can improve atherosclerotic cardiovascular (CV) disease (ASCVD) risk prediction in addition to a fasting or non-fasting lipid profile.

An expert panel considered the role of postprandial hypertriglyceridaemia (as represented by an OFTT) in predicting ASCVD. The panel updated its 2011 statement by considering new studies and various patient categories. The recommendations are based on expert opinion since no hard endpoint trials have been performed, Table 1.

Individuals with fasting TG concentration <1 mmol/L (89 mg/dL) commonly do not have an abnormal response to an OFTT. In contrast, those with fasting TG concentration ≥2 mmol/L (175 mg/dL) or non-fasting ≥2.3 mmol/L (200 mg/dL) will usually have an abnormal response. We recommend considering postprandial hypertriglyceridaemia testing when fasting TG concentrations and non-fasting TG concentrations are 1-2 mmol/L (89-175 mg/dL) and 1.3-2.3 mmol/L (115-200 mg/dL), respectively as an additional investigation for metabolic risk prediction along with other risk factors (obesity, current tobacco abuse, metabolic syndrome, hypertension, and diabetes mellitus). The panel proposes that an abnormal TG response to an OFTT (consisting of 75 g fat, 25 g carbohydrate and 10 g proteins) is >2.5 mmol/L (220 mg/dL).

Postprandial hypertriglyceridaemia is an emerging factor that may contribute to residual CV risk. This possibility requires further research. A standardised OFTT will allow comparisons between investigational studies. We acknowledge that the OFTT will be mainly used for research to further clarify the role of TG in relation to CV risk. For routine practice, there is a considerable support for the use of a single non-fasting sample.

Keywords:

Postprandial hypertriglyceridaemia, non-fasting triglycerides, remnant cholesterol, fat tolerance test, atherosclerotic cardiovascular disease.

Affiliation:

Cardiology Department and LDL-Apheresis Unit, Onassis Cardiac Surgery Center, Athens, Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), London, Lipid and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, Department of Cardiology, Tzanio Hospital, Piraeus, Department of Obesity and Metabolism, Hygeia Hospital, Athens, First Department of Internal Medicine, Division of Endocrinology-Metabolism, Diabetes Center, AHEPA University Hospital, Thessaloniki, Department of Medicine, Division of Endocrinology and Metabolism, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Lipid and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Cordoba, and CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen



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