Postprandial hyperlipidemia as a risk factor in patients with type 2 diabetes

ABSTRACT

Introduction: Postprandial hyperlipidemia is a common feature of the atherogenic dyslipidemia in patients with type 2 diabetes. Quantification of this with oral fat tolerance tests is not used routinely in clinical practice and abnormal postprandial lipids are usually inferred from non-fasting plasma triglyceride levels. Identifying excessive postprandial hyperlipidemia may help to refine cardiovascular risk assessment but there are no treatments currently available which selectively target postprandial lipids and no large cardiovascular outcome trials using this as the entry criterion.

Areas covered: In this review of relevant published material, we summarize the findings from the most important publications in this area.

Expert opinion: Postprandial hyperlipidemia appears to contribute to the cardiovascular risk in patients with diabetes. Non-fasting triglyceride levels provide a surrogate marker of postprandial hyperlipidemia but more specific markers such as apoB48 levels may prove to be more reliable. Omega-3 fatty acids, fibrates and ezetimibe can reduce postprandial lipids but may not correct them completely. Several novel treatments have been developed to target hypertriglyceridemia and some of these may be particularly effective in improving postprandial levels. Further clinical trials are needed to establish the role of postprandial lipids in assessment of cardiovascular risk and to identify the most effective treatments.

KEYWORDS:

• ApoB48
• diabetes
• hyperlipidemia
• hypertriglyceridemia
• non-fasting triglycerides
• oral fat tolerance test
• postprandial

Article highlights

• Patients with T2DM frequently have postprandial hyperlipidemia but it may not always be identified by non-fasting triglyceride levels.

• The oral fat tolerance test (OFTT) is not commonly used in clinical practice to identify postprandial hyperlipidemia although specific recommendations on the composition of the OFTT and indications when to use it have been developed.

• If more simple measures of postprandial hyperlipidemia, such as apoB48 levels, can be further validated, they could prove useful to identify patients at increased cardiovascular risk.

• Current lipid-lowering treatments, particularly those targeting triglycerides such as omega-3 fatty acids and fibrates, reduce postprandial hyperlipidemia but may not correct it completely.

• Newer drugs such as pemafibrate and those targeting apoCIII and ANGPTL3 may prove to be more effective in normalizing postprandial lipid levels in patients with T2DM.

This box summarizes key points contained in the article.

Declaration of interest

B Tomlinson has received research funding to perform clinical studies from Amgen Inc., Merck Sharp and Dome, Pfizer and Roche. B Tomlinson has acted as a consultant and speaker for Amgen Inc., Dr Reddy’s Laboratories Ltd, Kowa, Merck Serono, and Orient EuroPharma Co. Ltd. for which he received honoraria. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received consulting fees and research grant support from Martinas BioPharma, Corvidia Therapeutics, Acasti Pharma, and consulting fees from 89Bio, Pharmavite and AlaskOmega. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.