ReviewPostprandial Hyperglycemia/Hyperlipidemia (Postprandial Dysmetabolism) Is a Cardiovascular Risk Factor
Section snippets
Cardiovascular Risk of Postprandial Hyperglycemia
Recent studies have indicated that almost 2 of 3 patients who present with symptomatic CHD have abnormal glucose homeostasis.4 A significant proportion of these at-risk subjects would go undetected when screened with fasting glucose levels but would demonstrate hyperglycemia after meals or during oral glucose tolerance tests.5 Glucose tolerance is generally established by administering a 75-g glucose load in the fasting state. Impaired glucose tolerance, or prediabetes, is defined as a 2-hour
Postprandial Hyperlipidemia
Postprandial hyperlipidemia with elevated levels of triglycerides, chylomicron remnants, and free fatty acids results in oxidative stress and inflammation and may independently potentiate the adverse effects of postprandial hyperglycemia.1, 15 These elevated and protracted postmeal lipid levels are features of insulin resistance.
Triglycerides are traditionally measured in the fasting state, typically the lowest triglyceride level of the day. Levels of fasting and postprandial triglycerides are
How Postprandial Dysmetabolism Induces Atherosclerosis
Excessive intake of high-calorie, quickly digestible food results in abnormal surges in blood glucose, triglyceride, and free fatty acid levels. This bolus of energetic substrates essentially swamps the metabolic capabilities of the mitochondria in the overnourished muscle and adipose tissues.19 Glucose and free fatty acids overwhelm the Krebs cycle, stimulating excess production of nicotinamide adenine dinucleotide that outpaces the capacity for oxidative phosphorylation. This buildup of
Diet and exercise
Altering the type and/or amount of dietary carbohydrates can improve postprandial glucose and HbA1c levels.25, 26 The glycemic index is determined by comparing the increase in blood glucose after 50 g of a specific food with that noted after 50 g of oral glucose. Most prospective observational studies show that diets rich in high-glycemic index foods, especially when combined with low dietary fiber content, are independently associated with the development of type 2 diabetes and CHD.25
The
Pharmacologic Therapy for Postprandial Dysmetabolism
Statins exert strong intracellular antioxidant activity,1, 19 and these agents have been to shown to reduce inflammation and protect endothelial function in nondiabetic and diabetic subjects. Long-term statin therapy can reduce postprandial remnant lipoproteins.37 A recent study showed that atorvastatin acutely reduced the adverse effects of postprandial dysmetabolism in diabetic subjects.1 Short-term therapy with atorvastatin has been shown to blunt the postprandial increases in oxidative
Acknowledgment
We would like to acknowledge Jose Aceituno, who created the figures for this report, and Lori J. Wilson, who assisted with manuscript preparation.
References (52)
- et al.
Frequency of undiagnosed diabetes mellitus in patients with acute coronary syndrome
Am J Cardiol
(2005) - et al.
Postprandial glucose regulation: new data and new implications
Clin Ther
(2005) - et al.
Contributions of fasting and postprandial glucose to hemoglobin A1c
Endocr Pract
(2006) - et al.
The relationships between post-prandial lipaemia, endothelial function and oxidative stress in healthy individuals and patients with type 2 diabetes
Atherosclerosis
(2001) - et al.
Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women
Am J Clin Nutr
(2004) Postprandial glycemia, glycemic index, and the prevention of type 2 diabetes
Am J Clin Nutr
(2004)- et al.
Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer
Mayo Clin Proc
(2004) - et al.
Origins and evolution of the Western diet: health implications for the 21st century
Am J Clin Nutr
(2005) - et al.
Vinegar and peanut products as complementary foods to reduce postprandial glycemia
J Am Diet Assoc
(2005) - et al.
Metabolic effects of amino acid mixtures and whey protein in healthy subjects: studies using glucose-equivalent drinks
Am J Clin Nutr
(2007)