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

Abstract

Previous studies have suggested that for clinical purposes, subjects with fasting triglycerides (TGs) between 89-180mg/dl (1-2mmol/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<89mg/dl (<1mmol/l); (2) TG, 89-180mg/dl (1-2mmol/l); and (3) TG>180mg/dl (>2mmol/l). Postprandial TG concentration at any point > 220mg/dl (>2.5mmol/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 1-2mmol/l (89-180mg/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 (<1mmol/l, <89mg/dL) or increased TG (>2mmol/l, >180mg/dl).