Eleftheriadou Ioanna, Grigoropoulou Pinelop, Katsilambros Nicholas, Tentolouris Nicholas
1st Department of Propaedeutic Medicine, Athens University Medical School, Athens, Greece.
Curr Diabetes Rev. 2008 Nov;4(4):340-56. doi: 10.2174/157339908786241133.
Postprandial lipemia has emerged as an independent risk factor for coronary artery disease. In this systematic review we examined the effect of the medications used for the management of diabetes, obesity and dyslipidemia on postprandial lipemia. It should be mentioned that no standardization exists for a test meal and for the duration of observation postprandially to allow for direct comparisons between the published studies. Type 2 diabetes mellitus and insulin resistance are associated with enhanced postprandial lipemia. Insulin is effective in reducing both fasting and post prandial total triglyceride levels as well as triglycerides contained in the triglyceride-rich lipoprotein sub-fractions. Additionally, the newer rapid-acting insulin analogues seem to be more effective in the reduction of postprandial lipemia than the short-acting human insulins. Acarbose ameliorates postprandial lipemia and reduces the atherogenic chylomicron and very low density lipoprotein remnants. Metformin reduces both fasting and postprandial triglyceridemia, fasting and post-prandial free fatty acids and may increase the concentrations of the high density lipoprotein cholesterol. Sulfonylureas reduce fasting and postprandial triglyceride levels while data on the effect on high density lipoprotein levels are inconsistent. The effect of meglitinides on postprandial lipid metabolism is neutral. Rosiglitazone decreases fasting and postprandial free fatty acids but has no significant effect on fasting and postprandial triglycerides. Pioglitazone has additional beneficial effects on lipid metabolism because it reduces postprandial free fatty acids, fasting and postprandial triglycerides and increases high density lipoprotein cholesterol levels. Limited available data suggest that glucagon-like peptide-1 analogues and vildagliptin reduce postprandial lipemia through reduction of intestinally-derived triglycerides. No data exist on the effect of sitagliptin on postprandial lipemia. Orlistat improves postprandial lipemia by reducing the absorption of the dietary fat; no data exist on the effect of sibutramine and rimonabant on the metabolism of lipids in the postprandial state.
餐后血脂异常已成为冠状动脉疾病的一个独立危险因素。在本系统评价中，我们研究了用于治疗糖尿病、肥胖症和血脂异常的药物对餐后血脂异常的影响。应当提及的是，对于测试餐以及餐后观察时长，目前尚无标准化方案，这使得已发表研究之间无法进行直接比较。2型糖尿病和胰岛素抵抗与餐后血脂异常加剧相关。胰岛素在降低空腹及餐后总甘油三酯水平以及富含甘油三酯脂蛋白亚组分中的甘油三酯方面有效。此外，新型速效胰岛素类似物在降低餐后血脂异常方面似乎比短效人胰岛素更有效。阿卡波糖可改善餐后血脂异常，并减少致动脉粥样硬化的乳糜微粒和极低密度脂蛋白残粒。二甲双胍可降低空腹及餐后甘油三酯血症、空腹及餐后游离脂肪酸水平，并可能增加高密度脂蛋白胆固醇浓度。磺脲类药物可降低空腹及餐后甘油三酯水平，但关于其对高密度脂蛋白水平影响的数据并不一致。格列奈类药物对餐后脂质代谢的影响呈中性。罗格列酮可降低空腹及餐后游离脂肪酸，但对空腹及餐后甘油三酯无显著影响。吡格列酮对脂质代谢有额外的有益作用，因为它可降低餐后游离脂肪酸、空腹及餐后甘油三酯水平，并提高高密度脂蛋白胆固醇水平。有限的现有数据表明，胰高血糖素样肽-1类似物和维格列汀通过减少肠道来源的甘油三酯来降低餐后血脂异常。关于西他列汀对餐后血脂异常影响的数据尚无。奥利司他通过减少膳食脂肪的吸收来改善餐后血脂异常；关于西布曲明和利莫那班对餐后状态下脂质代谢影响的数据尚无。
