Who Would Benefit Most from Postprandial Lipid Screening?

Abstract

Abstract Objectives Individuals with healthy fasting triglycerides (TG) (<150 mg/dL) can still experience a deleterious postprandial TG response (≥220 mg/dL) to a high-fat/high-sugar meal (HFHSM), which has been shown to be a stronger predictor of cardiovascular disease (CVD) than fasting TG. The purpose of this study was to identify the lower and upper limits of fasting TG that indicate a benefit from additional postprandial screening. Methods We conducted a secondary analysis of 5 studies from our laboratory featuring 112 disease-free participants (age 19–76 y; 41 M/71F). For all studies, participants observed a 10-hour overnight fast after which they consumed a HFHSM (12–13 kcal/kg body mass; 61–63% fat). Serial blood draws were taken at fasting and serially every hour for 6 hours post-meal to assess the postprandial TG response. Results There was a strong positive association between fasting and peak TG (r = 0.84, P < 0.0001). Based on linear regression, starting at 19.4 mg/dL (i.e., the y-intercept), every 1.0 mg/dL increase in fasting TG was associated with a 2.022 mg/dL increase in peak TG. The model predicted that fasting TG ≥ 99.2 mg/dL (95% confidence interval [CI]: 93.9, 105.2) are likely to yield peak TG ≥ 220 mg/dL. In our sample, 92% (11/12) of individuals with fasting TG > 121 mg/dL exhibited peak TG ≥ 220 mg/dL, while 100% (51/51) of individuals with fasting TG < 66 mg/dL had peak TG that did not exceed ≥ 220 mg/dL. There was a moderate positive association (r = 0.42, P = 0.0036) between fasting and peak TG for individuals with fasting TG between 66 and 121 mg/dL, in which 30% (14/46) exhibited peak TG ≥ 220 mg/dL while 70% (32/46) did not. Conclusions Based on these preliminary analyses, individuals with fasting TG ≥ 99.2 mg/dL are expected to exceed peak TG of ≥ 220 mg/dL, a level that is associated with CVD risk. Our data suggest that postprandial TG testing is most useful for individuals with fasting TG of 66–121 mg/dL. Outside of this fasting TG range, postprandial TG responses are largely predictable. When complete, this study will inform recommendations for postprandial TG assessment in order to better detect CVD risk in the clinical setting and avoid unnecessary medical testing. Funding Sources These projects were funded by Oklahoma State University, Kansas State University, and the American Heart Association.