Clearance of chylomicron remnants in normolipidaemic patients with coronary artery disease: case control study over three years

Weintraub, Moshe; Grosskopf, Itamar; Rassin, Toby; Miller, Hylton; Charach, Gideon; Rotmensch, Heschi H.; Liron, M; Rubinstein, Ardon; Iaina, Adrian

doi:10.1136/bmj.312.7036.935

Cited by 207 publications

(135 citation statements)

References 40 publications

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“…Peak and late postprandial triglyceride concentrations have been associated with coronary atherosclerosis [7,26,27] and early carotid atherosclerosis [8,28]. Furthermore, postprandial retinyl palmitate concentrations, reflecting postprandial concentrations of chylomicrons and chylomicron remnants, are associated with CHD in case-control studies [29,30] and postprandial plasma concentrations of small chylomicron remnants are related to progression of coronary lesions as determined by sequential coronary angiographies [31].…”

Section: Discussionmentioning

confidence: 99%

Insulin and non-esterified fatty acid relations to alimentary lipaemia and plasma concentrations of postprandial triglyceride-rich lipoproteins in healthy middle-aged men

et al. 2000

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A cluster of risk factors for Type II (non-insulin-dependent) diabetes mellitus and cardiovascular disease, called the metabolic syndrome, is a common feature of otherwise healthy people living in industrialised countries. Increased visceral adipose tissue depots, insulin resistance with ensuing hyperinsulinaemia and dyslipoproteinaemia including hypertriglyceridaemia, a low HDL cholesterol concentration and a preponderance of small, dense LDL particles are central components of this syndrome [1]. The links between glucose-insulin homeostasis and lipoprotein metabolism have received particular atten- Abstract Aims/hypothesis. Enhanced and prolonged postprandial lipaemia is related to cardiovascular disease but how postprandial lipaemia is regulated is poorly known. We therefore determined the relations of fasting insulin concentrations to fasting and postprandial lipids, lipoproteins and non-esterified fatty acids in middle-aged men. Methods. The subjects, 99 healthy 50-year-old men with an apolipoprotein E3/3 genotype, ate a mixed meal. The apolipoprotein B-48 and B-100 contents were determined in triglyceride-rich lipoproteins as a measure of chylomicron remnant and very low density lipoprotein particle concentrations. Results. Fasting plasma insulin was associated with the triglyceride response to the test meal, independently of body mass index, waist-to-hip circumference ratio, blood glucose and the insulin effect on fasting plasma triglycerides. Exaggerated and prolonged postprandial lipaemia in subjects in the upper quartile of the plasma insulin distribution was largely accounted for by large (Svedberg flotation rate > 60) very low density lipoproteins and chylomicron remnants. Insulin relations to large postprandial triglyceride-rich lipoproteins exclusively reflected the association between plasma insulin and the fasting plasma concentrations of these lipoprotein species, whereas plasma insulin and late postprandial plasma concentrations of small (Svedberg flotation rate 20±60) chylomicron remnants were related, independently of insulin influences on fasting concentrations. Strong positive relations were found between the late increases in large triglyceride-rich lipoproteins and plasma non-esterified fatty acid concentrations after 6 h. Conclusion/interpretation. The degree of insulin sensitivity is a major determinant of postprandial lipaemia in healthy middle-aged men and could add to the regulation of the basal production of large triglyceride-rich lipoproteins. [Diabetologia (2000)

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Section: Discussionmentioning

confidence: 99%

Insulin and non-esterified fatty acid relations to alimentary lipaemia and plasma concentrations of postprandial triglyceride-rich lipoproteins in healthy middle-aged men

et al. 2000

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“…42 The clinical relevance of this may be evident from recent case-control studies; postprandial plasma concentrations of TAG are strongly predictive of the presence or absence of CVD. 6,43,44 Thus, there is increasing research interest in the study of metabolic events during the postprandial period and of interventions, including exercise, which modify these.…”

Section: Exercise and Postprandial Lipid And Lipoprotein Metabolismmentioning

confidence: 99%

Physical activity, obesity and blood lipids

Hardman

1999

Int J Obes

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PURPOSE: To present the evidence concerning the in¯uence of physical activity on the dyslipidaemia of obesity and overweight. METHODS: Review of a personal library of literature on the interactions of physical activity, lipoprotein metabolism and body fatness. SUMMARY OF FINDINGS: Obesity, in particular abdominal obesity, is associated with dyslipidaemia Ð speci®cally elevated plasma concentrations of triacylglycerol (TAG) in the fasted state, an exaggerated postprandial rise in plasma TAG, low concentrations of high density lipoprotein cholesterol (HDL) and possibly a preponderance of small dense low density lipoproteins. Regular physical activity contributes to the avoidance of overweight and hence to the development of dyslipidaemia. Although low levels of body fatness contribute to the high levels of HDL cholesterol and the low levels of TAG in trained people there are other important determinants of these characteristics. In particular, exercise (and probably training, that is regular, frequent exercise over months and years) enhances the metabolic capacity for TAG, possibly through mechanisms involving increased activity of lipoprotein lipase. This, in turn, has effects on other lipoprotein species such that the transport of TAG and cholesterol in the circulation is improved. There is evidence for a dose ± response relationship, with for example, higher levels of HDL cholesterol in men and women who expend more energy in exercise. For the majority of healthy, sedentary adults frequent, moderate intensity exercise equivalent to a total gross energy expenditure of about 8.5 MJ per week is probably a suf®cient to in¯uence lipoprotein lipids.

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“…1 Several studies have described abnormalities in postprandial metabolism in patients with coronary artery disease, 2 ± 4 and shown that postprandial triglycerides (TG) are independent predictors of coronary artery disease in multivariate analysis, 5 even after adjustment for fasting TG or HDL-cholesterol in normolipidemic men. 6 Obesity is associated with abnormal fasting lipid parameters such as increased fasting triglyceride and decreased HDL-cholesterol, 7 which could explain, at least in part, the greater development of cardiovascular disease in obese people. Nevertheless, obesity appears to be an independent risk factor for coronary artery disease, even in subjects with normal fasting plasma lipids and normal glucose tolerance.…”

Section: Introductionmentioning

confidence: 99%

Relationship between altered postprandial lipemia and insulin resistance in normolipidemic and normoglucose tolerant obese patients

et al. 2000

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OBJECTIVE: Although there are changes in the postprandial lipid responses of obese patients, these are closely associated with high fasting triglycerides (TG). This study of 17 normotriglyceridemic, normoglucose-tolerant android obese subjects (body mass index, BMI 34.3 AE 3.1 kgam 2 ) and 33 normal-weight controls (BMI 21.8 AE 1.6 kgam 2 ) was done to examine their postprandial responses to an oral fat loading test containing retinol (890 calories, 85% fat) and to evaluate the possible association between clinical and biological features of obesity andaor insulin resistance and postprandial lipemia. SUBJECTS AND MEASUREMENTS: Blood samples were taken before giving the fat load and at 2,3,4,5,6 and 8 h after it. Insulin sensitivity was assessed using HOMA, and TG and retinyl palmitate (RP) in the plasma, chylomicrons and non-chylomicron fractions were measured each time. RESULTS: The areas under the curves (AUC) of chylomicron TG for the obese and controls were not different, indicating adequate lipolytic activity. By contrast, the AUC for non-chylomicron TG was signi®cantly greater in the obese than in the controls (512 AE 135 vs 429 AE 141 mmolal min, P`0.01). In addition, the AUC for RP in this same fraction was signi®cantly lower in the obese than in the controls (103 AE 55 vs 157 AE 88 mgal min, P`0.05), suggesting that the TG from endogenous lipoproteins accounted for most of the increase in TG in the non chylomicron fraction. Parameters related to obesity showed no relationship with these postprandial abnormalities, whereas HOMA, which discriminated between the groups, partly explained (r 2 23%, P`0.01) the signi®cant increase in non-chylomicron TG. CONCLUSIONS: Android obese patients with a fasting TG in the normal range and not different from the fasting TG of lean controls had an abnormal postprandial lipemia response, indicated by a signi®cantly greater TG in the nonchylomicron subfraction than in controls. These alterations may be partly due to postprandial changes in endogenous lipoproteins as a consequence of insulin resistance.

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Clearance of chylomicron remnants in normolipidaemic patients with coronary artery disease: case control study over three years

Cited by 207 publications

References 40 publications

Insulin and non-esterified fatty acid relations to alimentary lipaemia and plasma concentrations of postprandial triglyceride-rich lipoproteins in healthy middle-aged men

Insulin and non-esterified fatty acid relations to alimentary lipaemia and plasma concentrations of postprandial triglyceride-rich lipoproteins in healthy middle-aged men

Physical activity, obesity and blood lipids

Relationship between altered postprandial lipemia and insulin resistance in normolipidemic and normoglucose tolerant obese patients

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