Abstract 16791: Elevated Post-Prandial Triglyceride Concentrations Are Associated with an Unfavorable Cardiometabolic Risk Factor Profile in Patients with Coronary Artery Disease
Background: The role of the post-prandial triglyceride (ppTG) metabolism for cardiovascular risk has not been studied prospectively.
Study design: The cohort of this prospective study consisted of N=514 consecutive patients with documented stable coronary artery disease (CAD) (83% male, 17% female, age 66±0.4 years), who were subjected to a novel sequential oral triglyceride and glucose tolerance test (OTT / OGT). The test protocol (75g cream fat given 3 hours prior to 75g glucose) was previously characterized and validated.
Results: Patients with normal glucose tolerance (N=126) had the lowest fasting (fTG) (108±4mg/dl) and ppTG (195±7mg/dl) concentrations, whereas patients with pathologic glucose tolerance (n=150; fTG 167±10mg/dl vs. ppTG 293±14mg/dl) and patients with diabetes (n=238; fTG 175±11mg/dl vs. ppTG 297±12mg/dl) were characterized by elevated fTG and ppTG. The mean relative TG increase (% vs. baseline) was comparable between subgroups. However, patients showed a large inter-individual variability with respect to ppTG metabolism within each group. Patients in the upper compared to the lower ppTG tertile were younger and had a more severe cardiovascular risk profile (e.g. more active smokers, higher blood pressure, higher body mass index and waist-to-hip-ratio). There were no differences in the angiographic extent of CAD, heart rate or medication. Patients in the upper ppTG tertile had higher concentrations of fasting glucose and insulin, HbA1c, total and LDL cholesterol, whereas HDL was lower. Markers of ppTG metabolism including area under the curve and maximal TG increase per hour were significantly elevated in these patients (p<0.01, Chi2 or ANOVA where indicated). Underscoring these findings, 53% of patients in ppTG tertile 3 vs. 38% in tertile 1 had diabetes and 76% vs. 32% in tertile 1 met the WHO definition criteria of the metabolic syndrome.
Conclusions: Elevated ppTG concentrations characterize CAD patients with a high burden of cardiometabolic risk factors. Interestingly, patients differed strongly in the individual ppTG response. Multivariable analyses of cardiovascular events after the 12-months follow-up show that assessment of ppTG metabolism improves risk stratification in CAD patients.
- © 2011 by American Heart Association, Inc.