Cardiology Department and LDL-Apheresis Unit, Onassis Cardiac Surgery Center, Athens, Greece.
Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Australia.
Curr Vasc Pharmacol. 2019;17(5):498-514. doi: 10.2174/1570161117666190507110519.
Residual vascular risk exists despite the aggressive lowering of Low-Density Lipoprotein Cholesterol (LDL-C). A contributor to this residual risk may be elevated fasting, or non-fasting, levels of Triglyceride (TG)-rich lipoproteins. Therefore, there is a need to establish whethe a standardised Oral Fat Tolerance Test (OFTT) can improve atherosclerotic Cardiovascular (CV) Disease (ASCVD) risk prediction in addition to a fasting or non-fasting lipid profile. An expert panel considered the role of postprandial hypertriglyceridaemia (as represented by an OFTT) in predicting ASCVD. The panel updated its 2011 statement by considering new studies and various patient categories. The recommendations are based on expert opinion since no strict endpoint trials have been performed. Individuals with fasting TG concentration <1 mmol/L (89 mg/dL) commonly do not have an abnormal response to an OFTT. In contrast, those with fasting TG concentration ≥2 mmol/L (175 mg/dL) or nonfasting ≥2.3 mmol/L (200 mg/dL) will usually have an abnormal response. We recommend considering postprandial hypertriglyceridaemia testing when fasting TG concentrations and non-fasting TG concentrations are 1-2 mmol/L (89-175 mg/dL) and 1.3-2.3 mmol/L (115-200 mg/dL), respectively as an additional investigation for metabolic risk prediction along with other risk factors (obesity, current tobacco abuse, metabolic syndrome, hypertension, and diabetes mellitus). The panel proposes that an abnormal TG response to an OFTT (consisting of 75 g fat, 25 g carbohydrate and 10 g proteins) is >2.5 mmol/L (220 mg/dL). Postprandial hypertriglyceridaemia is an emerging factor that may contribute to residual CV risk. This possibility requires further research. A standardised OFTT will allow comparisons between investigational studies. We acknowledge that the OFTT will be mainly used for research to further clarify the role of TG in relation to CV risk. For routine practice, there is a considerable support for the use of a single non-fasting sample.
尽管已经积极降低了低密度脂蛋白胆固醇（LDL-C），但仍存在残余的血管风险。这种残余风险的一个促成因素可能是空腹或非空腹时甘油三酯（TG）丰富的脂蛋白水平升高。因此，需要确定标准化口服脂肪耐量试验（OFTT）是否可以在空腹或非空腹血脂谱的基础上进一步提高动脉粥样硬化性心血管疾病（ASCVD）风险预测。一个专家小组考虑了餐后高甘油三酯血症（如 OFTT 所代表的）在预测 ASCVD 中的作用。该小组通过考虑新的研究和各种患者类别更新了其 2011 年的声明。由于没有进行严格的终点试验，因此这些建议基于专家意见。空腹甘油三酯浓度<1 mmol/L（89 mg/dL）的个体通常对 OFTT 无异常反应。相比之下，空腹甘油三酯浓度≥2 mmol/L（175 mg/dL）或非空腹≥2.3 mmol/L（200 mg/dL）的个体通常会有异常反应。我们建议，当空腹甘油三酯浓度和非空腹甘油三酯浓度分别为 1-2 mmol/L（89-175 mg/dL）和 1.3-2.3 mmol/L（115-200 mg/dL）时，考虑餐后高甘油三酯血症检测作为代谢风险预测的附加检查，与其他危险因素（肥胖、当前吸烟、代谢综合征、高血压和糖尿病）一起。专家组建议，OFTT（由 75 g 脂肪、25 g 碳水化合物和 10 g 蛋白质组成）的异常 TG 反应>2.5 mmol/L（220 mg/dL）。餐后高甘油三酯血症是一个新出现的可能导致残余心血管风险的因素。这一可能性需要进一步研究。标准化 OFTT 将允许对研究进行比较。我们承认，OFTT 将主要用于研究，以进一步澄清 TG 与心血管风险的关系。对于常规实践，有相当多的支持使用单一的非空腹样本。
