Abstract 1082: Characterization of a Sequential Protocol for the Simultaneous Determination of Oral Triglyceride and Glucose Tolerance in 400 Patients With Coronary Artery Disease
Background: Epidemiologic studies suggest an association of post-prandial triglyceride (TG) levels with the risk of future cardiovascular events, whereas fasting TG levels may be less predictive. The Homburg Cream and Sugar Study prospectively evaluates the role of post-prandial TG metabolism in patients with coronary artery disease (CAD).
Methods and Results: Pilot experiments in 25 healthy subjects and 20 patients with CAD demonstrated that a novel sequential oral triglyceride and glucose tolerance test (OTT->OGT, 75g fat applied 3 hours prior to 75g glucose) reliably determines TG and glucose tolerance at the same time and shows no significant differences in triglyceride kinetics compared to 75g fat without glucose (OTT). N=400 consecutive patients with stable CAD were subjected to the OTT->OGT, patients with diabetes received the OTT. Within the CAD patients, individuals without metabolic syndrome and normal glucose tolerance (n=82) showed the lowest TG values (fasting 100±4 mg/dl, TG max. 177±8 mg/dl). Patients with CAD + MS and impaired glucose tolerance/diabetes (IGT/DM) had the highest TG values (n=190, fasting 186±9 mg/dl, TG max. 323±14 mg/dl). CAD patients with MS but no IGT/DM (n=54, fasting 137±7 mg/dl, TG max. 263±15 mg/dl) and patients with IGT/DM but no MS (n=74, fasting 122±6 mg/dl, TG max. 235±14 mg/dl) showed a significantly lower postprandial TG increase. However, the latter group was the only group to show a further TG increase between 4–5 hours post OTT, suggesting a delayed TG clearance in diabetic CAD patients. Importantly, in all patient groups the relative post-prandial TG increase did not correlate to the absolute TG increase.
Conclusions: TG tolerance and glucose tolerance can be simultaneously measured in CAD patients using a sequential test protocol. Metabolic syndrome and diabetes are correlated to elevated fasting and post-prandial TG levels. CAD patients show marked individual differences between their absolute and relative post-prandial TG response. Follow-up examinations will elucidate whether parameters of post-prandial triglyceride metabolism correlate with cardiovascular events and whether the test identifies patients with elevated TG-associated cardiovascular risk.