Postprandial metabolic heterogeneity in men with primary dyslipidaemia

Abstract

IntroductionFamilial combined hyperlipidaemia (FCH) and familial hypercholesterolaemia (FH) have been strongly linked to premature coronary artery disease. Postprandial hypertriglyceridaemia is also associated with atherosclerotic disease. We evaluated the postprandial lipaemia in men with FCH and FH and compared them to a group of healthy men.Material and methodsThe study population consisted of 83 men: 34 FCH, 29 FH and 20 healthy. The FCH and FH groups were further divided into five subgroups, according to their lipid phenotype: FCH-IIA (n = 13), FCH-IIB (n = 10), FCH-IV (n = 11), FH-IIA (n = 21) and FH-IIB (n = 8). Postprandial lipaemia was evaluated by the areas under the curve for triglyceride (TG) concentrations (TG-AUC).ResultsThe TG levels after oral fat tolerance test were significantly higher in FCH, compared to FH and healthy groups (TG-AUC in mg/dl/h; 2678 ±1415 vs. 1503 ±1147 and 1011 ±652 respectively, p < 0.001). The postprandial response was higher in FCH-IV and FCH-IIB, compared to FCH-IIA (TG-AUC in mg/dl/h; 3220 ±824 or 3409 ±770 vs. 1863 ±577 respectively, p < 0.001, for both comparisons). The FCH-IIA group showed higher postprandial TG levels when compared to FH-IIA (TG-AUC in mg/dl/h; 1863 ±577 vs. 1374 ±428 respectively, p = 0.008). There were no significant differences between FH-IIB and FCH-IIB subgroups. There was a significant correlation (r = 0.907, p < 0.001) between the postprandial TG-AUC and fasting TG levels in all FCH subjects.ConclusionsAll phenotypes of FCH and the FH IIB phenotype demonstrate an exaggerated postprandial response that could partially contribute to the high cardiovascular risk. These patients should be identified and treated early with the appropriate hypolipidaemic agents.

Postprandial lipemia as a cardiometabolic risk factor

“…Postprandial TG and lipoprotein level increase is a physiological and transitory event; however, a postprandial TRL accumulation is a key feature of the atherogenic lipid phenotype present in several pathological conditions, including insulin resistance 22 and type 2 diabetes mellitus 23 as well as in subjects with primary dyslipidemias such as familial hypercholesterolemia (FH) 24 or combined hyperlipidemia 25 . In healthy people, plasma TG levels peak 3-4 h after the ingestion of a fat meal and tend to return to baseline within 6-8 h; under pathological conditions postprandial lipemia peak is 2-3-fold higher and prolonged; plasma TG levels remain elevated up to 10-12 h 20 .…”

Influence of metabolic syndrome superposition on familial combined hyperlipoproteinemia cardiovascular complication rate

“…Moreover, we did not select an age-matched sample of non FCHL-affected subjects to evaluate whether the presence of MS is more dangerous for FCHL patients than for non-FCHL subjects. Furthermore, we did not standardize the patients on the basis of their diet, which could strongly influence the lipid phenotype of both conditions [26, 27]. Another limitation of our study is that the OR calculation for association of MS components with cardiovascular complications was made considering the MS features as categorical, because of the inclusion of a large number of hypertensive subjects treated with antihypertensive drugs.…”

Is it time to break the fast?—a paradigm shift in clinical lipidology

“…Patients with Familial Combined Hyperlipidemia (FCH) show changing lipoprotein phenotypes with sometimes increased LDL-C and/or TGs. Several studies, with both self-measurements of capillary TGs and fat loading tests, have shown that patients with FCH have persistent postprandial hypertriglyceridemia compared with normolipidemic subjects (19,20). In fact, this is not surprising due to the fact that these subjects usually have fasting hypertriglyceridemia.…”