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



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.



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.



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.



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).
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: pablopermar@yahoo.es.
Pablo
P
Perez-Martinez
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Juan F
JF
Alcala-Diaz
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Edmon K
EK
Kabagambe
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Antonio
A
Garcia-Rios
Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN, USA.
Michael Y
MY
Tsai
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Javier
J
Delgado-Lista
1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
Genovefa
G
Kolovou
Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA.
Robert J
RJ
Straka
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Francisco
F
Gomez-Delgado
Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA.
Paul N
PN
Hopkins
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Carmen
C
Marin
Division of Statistical Genomics in the Center for Genome Sciences of the Washington University, St. Louis, USA.
Ingrid
I
Borecki
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Elena M
EM
Yubero-Serrano
Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, USA.
James E
JE
Hixson
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Antonio
A
Camargo
Department of Genetics Division of Statistical Genomics, Washington University School of Medicine, St. Louis, MO, USA.
Michael A
MA
Province
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Javier
J
Lopez-Moreno
Biochemical Laboratory, Hospital Universitario Reina Sofia, Cordoba, Spain.
Fernando
F
Rodriguez-Cantalejo
CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Endocrinologia y Nutricion, Hospital Clinico Virgen de la Victoria, Malaga, Spain.
Francisco J
FJ
Tinahones
Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London, London, UK.
Dimitri P
DP
Mikhailidis
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Francisco
F
Perez-Jimenez
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Donna K
DK
Arnett
Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University School of Medicine, Boston, MA, USA; Department of Epidemiology, National Center of Cardiovascular Investigations, Madrid, Spain; Madrid Institute of Advanced Studies-Food, Madrid, Spain.
Jose M
JM
Ordovas
Lipid and Atherosclerosis Unit, Department of Internal Medicine, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
Jose
J
Lopez-Miranda
D000328:Adult; D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D004041:Dietary Fats; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019518:Postprandial Period; D015995:Prevalence; D014280:Triglycerides / Q000097:blood*
D004041:Dietary Fats; D014280:Triglycerides
CORDIOPREV study; Coronary heart disease; GOLDN study; Oral-fat tolerance test; Postprandial lipemia; Triglycerides
Lipids Health Dis. 2011 Oct 18;10:181
22008512
Clin Pharmacol Ther. 2014 Jul;96(1):57-63
24727469
JAMA. 2007 Jul 18;298(3):309-16
17635891
Circulation. 2009 Oct 20;120(16):1640-5
19805654
Br J Nutr. 2007 Sep;98(3):458-73
17705891
Am J Clin Nutr. 2009 Jan;89(1):391-9
19056598
J Nat Sci Biol Med. 2012 Jan;3(1):65-70
22690054
Curr Vasc Pharmacol. 2011 May;9(3):258-70
21314632
Arterioscler Thromb Vasc Biol. 1998 Apr;18(4):526-34
9555857
Diabetologia. 1985 Jul;28(7):412-9
3899825
Am Heart J. 2016 Jul;177:42-50
27297848
J Lab Clin Med. 2005 Jun;145(6):323-7
15976761
Atheroscler Suppl. 2015 Feb;17:12-6
25659871
PLoS One. 2014 May 06;9(5):e96297
24802225
Eur J Clin Invest. 2014 Nov;44(11):1053-64
25231836
JAMA. 2007 Jul 18;298(3):299-308
17635890
Circulation. 2008 Nov 11;118(20):2047-56
18955664
Arterioscler Thromb. 1992 Nov;12(11):1336-45
1420093
Eur Heart J. 2011 Jun;32(11):1345-61
21531743
Curr Atheroscler Rep. 2013 Mar;15(3):309
23345190
Eur J Clin Invest. 2000 Jul;30(7):578-85
10886297
Lancet. 2014 Aug 16;384(9943):626-635
25131982
Atherosclerosis. 1998 Dec;141 Suppl 1:S105-7
9888652
Clin Lab Med. 2006 Dec;26(4):773-86
17110239
J Clin Endocrinol Metab. 2004 Sep;89(9):4721-8
15356086
Atherosclerosis. 2009 Apr;203(2):633-9
18804210
Arterioscler Thromb Vasc Biol. 2007 Jun;27(6):1417-25
17431185
Atheroscler Suppl. 2010 Jun;11(1):39-43
20434407
Proc Natl Acad Sci U S A. 1993 Mar 1;90(5):2069-73
8446630
J Lipid Res. 1988 Apr;29(4):469-79
3392464
Curr Vasc Pharmacol. 2011 May;9(3):271-80
21314631
Nutr Metab Cardiovasc Dis. 2011 Jan;21(1):39-45
19819118
Clin Chim Acta. 2014 Apr 20;431:131-42
24508990
J Mol Endocrinol. 2004 Feb;32(1):237-45
14766005
Curr Opin Cardiol. 2013 Jul;28(4):446-51
23591556