title: Postprandial Peaking and Plateauing of Triglycerides and VLDL in Patients with Underlying Cardiovascular Diseases Despite Treatment.
abstract: BACKGROUND
  Dyslipidemia is associated with cardiovascular morbidities and mortality. Currently, fasting lipid profile determination is used to monitor treatment response. Recently, postprandial lipemia is of increasing interest because of its atherogenic and thrombogenic potential and also was found to be more predictive for cardiovascular diseases.
  
  
  OBJECTIVE
  To demonstrate postprandial lipemia among patients with cardiovascular diseases despite low fat diet, normal fasting lipid profile and even statin regimen.
  
  
  METHODS
  Patients aged 40-80 years old with cardiovascular diseases (i.e. coronary artery disease and cerebrovascular disease) more than 6 months, on statin treatment for more than 6 months and normal fasting lipid profile (according to NCEP ATP III guidelines) were included. Study exclusion criteria were pregnancy, acute cardiovascular events < 6 months, hepatic or renal failure. Finally, twelve patients were included.
  
  
  RESULTS
  The triglyceride level showed a significant rise from fasting to 2 hours after breakfast with a mean difference of 23.86 mg/dL (P =0.012). The level peaked at 4 hours after breakfast with a mean difference (MD) of 72.02 mg/dL (P =0.002). Subsequent triglyceride levels plateaued and were significantly higher than the baseline (P <0.05) until the 12th hour of observation. VLDL levels showed a similar pattern. Levels increased significantly from fasting to 2h after breakfast (mean difference: 4.49 mg/dL, P = 0.007), then plateaued and further increased 4 hours after breakfast (MD: 14.01 mg/dL, P = 0.002). VLDL levels were significantly higher than fasting (P < 0.05) and did not return to baseline until the 12th hour of observation. In contrast, the levels of total cholesterol, HDL and LDL decreased postprandially.
  
  
  CONCLUSIONS
  Triglyceride and VLDL peaking and plateauing were observed in patients with cardiovascular diseases despite low fat diet, normal fasting lipid profile and statin regimen. These findings may raise more attentions in monitoring and management of dyslipidemia in patients with cardiovascular and cerebrovascular events.
authors.affiliation: Section of Endocrinology and Metabolism, University Of Santo Tomas Hospital, Manila, Philippines.
authors.forename: Clarissa E
authors.initials: CE
authors.lastname: Samson
authors.forename: Ana Lyza B
authors.initials: AL
authors.lastname: Galia
authors.forename: Khristine Ivy C
authors.initials: KI
authors.lastname: Llave
authors.forename: Manuel B
authors.initials: MB
authors.lastname: Zacarias
authors.forename: Leilani B
authors.initials: LB
authors.lastname: Mercado-Asis
keywords: Cardiovasular Disease; Postprandial Lipemia; Triglyceride; VLDL