Assessment and Clinical Relevance of Non-Fasting and Postprandial Triglycerides: An Expert Panel Statement

Genovefa      D. Kolovou; Dimitri      P. Mikhailidis; Jan      Kovar; Dennis      Lairon; Borge      G. Nordestgaard; Teik      Chye Ooi; Pablo      Perez-Martinez; Helen      Bilianou; Katherine      Anagnostopoulou; George      Panotopoulos

Abstract

An Expert Panel group of scientists and clinicians met to consider several aspects related to non-fasting and postprandial triglycerides (TGs) and their role as risk factors for cardiovascular disease (CVD). In this context, we review recent epidemiological studies relevant to elevated non-fasting TGs as a risk factor for CVD and provide a suggested classification of non-fasting TG concentration. Secondly, we sought to describe methodologies to evaluate postprandial TG using a fat tolerance test (FTT) in the clinic. Thirdly, we discuss the role of non-fasting lipids in the treatment of postprandial hyperlipemia. Finally, we provide a series of clinical recommendations relating to non-fasting TGs based on the consensus of the Expert Panel: 1). Elevated non-fasting TGs are a risk factor for CVD. 2). The desirable non-fasting TG concentration is < 2 mmol/l ( < 180 mg/dl). 3). For standardized postprandial testing, a single FTT meal should be given after an 8 h fast and should consist of 75 g of fat, 25 g of carbohydrates and 10 g of protein. 4). A single TG measurement 4 h after a FTT meal provides a good evaluation of the postprandial TG response. 5). Preferably, subjects with non-fasting TG levels of 1-2 mmol/l (89-180 mg/dl) should be tested with a FTT. 6). TG concentration ≤ 2.5 mmol/l (220 mg/dl) at any time after a FTT meal should be considered as a desirable postprandial TG response. 7). A higher and undesirable postprandial TG response could be treated by aggressive lifestyle modification (including nutritional supplementation) and/or TG lowering drugs like statins, fibrates and nicotinic acid.

Keywords: Postprandial triglycerides, non-fasting triglycerides, chylomicron remnants, very low density lipoprotein remnants, fat tolerance test, cardiovascular disease, statins, fibrates, nicotinic acid, type IIb hyperlipidemia