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

Authors: PEREZ-MARTINEZ, PABLO - UNIVERSIDAD DE CORDOBA; ALCALA-DIAZ, JUAN - UNIVERSIDAD DE CORDOBA; KABAGAMBE, EDMOND - VANDERBILT UNIVERSITY; GARCIA-RIOS, ANTONIO - UNIVERSIDAD DE CORDOBA; TSAI, MICHAEL - UNIVERSITY OF MINNESOTA; DELGADO-LISTA, JAVIER - UNIVERSIDAD DE CORDOBA; KOLOBOU, GENOVEFA - ONASSIS CARDIAC SURGERY CENTER; STRAKA, ROBERT - UNIVERSITY OF MINNESOTA; GOMEZ-DELGADO, FRANCISCO - UNIVERSIDAD DE CORDOBA; HOPKINS, PAUL - UNIVERSITY OF UTAH; MARIN, CARMEN - UNIVERSIDAD DE CORDOBA; BORECKI, INGRID - WASHINGTON UNIVERSITY; YUBERO-SERRANO, ELENA - UNIVERSIDAD DE CORDOBA; HIXSON, JAMES - UNIVERSITY OF TEXAS; CAMARGO, ANTONIO - UNIVERSIDAD DE CORDOBA; PROVINCE, MICHAEL - WASHINGTON UNIVERSITY; LOPEZ-MORENO, JAVIER - UNIVERSIDAD DE CORDOBA; RODRIGUEZ-CANTALEJO, FERNANDO - UNIVERSITY HOSPITAL REINA SOFIA; TINAHONES, FRANCISCO - HOSPITAL UNIVERSITARIO VIRGEN DE LA VICTORIA; MIKHAILIDIS, DIMITRI - UNIVERSITY COLLEGE LONDON; PEREZ-JIMENEZ, FRANCISCO - INSTITUTO DE SALUD CARLOS III; ARNETT, DONNA - UNIVERSITY OF ALABAMA; ORDOVAS, JOSE - JEAN MAYER HUMAN NUTRITION RESEARCH CENTER ON AGING AT TUFTS UNIVERSITY; LOPEZ-MIRANDA, JOSE - UNIVERSIDAD DE CORDOBA

Submitted to: Journal of Clinical Lipidology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/25/2016
Publication Date: 6/1/2016
Citation: Perez-Martinez, P., Alcala-Diaz, J.F., Kabagambe, E.K., Garcia-Rios, A., Tsai, M.Y., Delgado-Lista, J., Kolobou, G., Straka, R.J., Gomez-Delgado, F., Hopkins, P.N., Marin, C., Borecki, I.B., Yubero-Serrano, E.M., Hixson, J.E., Camargo, A., Province, M.A., Lopez-Moreno, J., Rodriguez-Cantalejo, F., Tinahones, F.J., Mikhailidis, D., Perez-Jimenez, F., Arnett, D.K., Ordovas, J.M., Lopez-Miranda, J. 2016. Assessment of postprandial triglycerides in clinical practice: validation in a general population and coronary heart disease patients. Journal of Clinical Lipidology. doi: 10.1016/j.jacl.2016.05.009.

Interpretive Summary: The current clinical approach to measure plasma lipids is to collect a blood sample in the fasting state. However, this approach may not be enough to reveal lipid disorder in all individuals, and it has been suggested that for clinical purposes, subjects with fasting triglycerides (TGs) in the middle range (89-180 mg/dl) would benefit from testing the levels of TGs after a high-fat meal (postprandial state.) Our objective was to determine the postprandial TG response in 2 independent studies and to validate who would benefit diagnostically from an oral-fat tolerance test (OFTT) in clinical practice. For this purpose we used a population of 1,002 patients with coronary heart disease (CHD) from the CORDIOPREV clinical trial and 1,115 white US subjects from the GOLDN study. Subjects were classified into low, medium, and high TGs, and their TG postprandial responses were analyzed. Our data show that an OFTT is useful in identifying postprandial hyperlipidemia in subjects with fasting TG between 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 (<89 mg/dL) or increased TG (>180 mg/dL.)

Technical Abstract: 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 pre-established 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 OFTT 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 mmol/l, <89 mg/dL) or increased TG (>2 mmol/l, >180 mg/dl).