Abstract 19044: Metabolic Syndrome and Diabetes Mellitus Determine the Absolute and Relative Triglyceride Metabolism Following a Sequential Triglyceride and Glucose Tolerance Test in 514 Patients With Coronary Artery Disease
Background: Compared to fasting triglyceride (TG) levels, postprandial (pp) TG levels may predict the risk of future cardiovascular events more effectively. This hypothesis has not been tested prospectively in cardiovascular high risk patients. We developed a novel sequential oral triglyceride and glucose tolerance test (OTTT->OGT) to determine ppTG and glucose tolerance in patients with coronary artery disease (CAD).
Methods and Results: Cross-over tests in healthy individuals and in CAD patients showed that the sequential metabolic provocation test (75g cream fat given 3h prior to 75g glucose) determines TG and glucose tolerance as reliable as the OTTT or OGT alone. The sequential OTTT->OGT test protocol was applied in 514 consecutive patients with clinically stable documented CAD after overnight fast (age 66±0.4 years, 83% men, 17% women), diabetic patients received the OGT only. TG and glucose metabolism were assessed at hours 0, 3, 4 and 5. Patients without metabolic syndrome (MS) and normal glucose tolerance (n=110) showed the lowest TG levels (fasting TG 137±3, max. TG 250±6mg/dl). CAD patients with diabetes (DM) but no MS showed comparable TG levels within the first 4 hours, but TG levels still increased markedly (15mg/dl) between hour 4 and 5, while TG levels were stable or declining in all other groups. The large group of patients with CAD, MS and DM (n=306) exhibited the highest absolute TG increase (fasting 183±10, max. 322±11mg/dl). Detailed analyses of TG kinetics showed that patients with an insulin-dependent DM (IDDM) exhibited a delayed absolute and relative ppTG clearance with the slowest overall TG increase of all groups and the highest TG increase between hours 4 and 5 after the OTTT.
Conclusion: CAD patients with a metabolic syndrome exhibit elevated fasting and ppTG levels, a large area under the TG curve and a high early TG increase. Absolute and relative TG clearance are significantly delayed by the presence of a concomitant IDDM. Notably, there is a large inter-individual variability of TG metabolism within these subgroups. Prospective 12 months follow-up of the patients is performed to test whether impaired postprandial TG tolerance is associated with cardiovascular events.
- © 2010 by American Heart Association, Inc.