Although the fed state predominates over the course of a day, the fasting
lipid profile has traditionally been used to assess
cardiovascular disease (CVD) risk. The nonfasting
lipid profile may be more reflective of the daily circulating plasma
lipids and simplifies
lipid monitoring for patients, laboratories, and clinicians. Nonfasting
triglyceride levels are also independently associated with cardiovascular events, leading to several clinical guidelines (e.g. in Denmark, the UK, Europe, and Canada) now recommending nonfasting
lipid testing in the primary prevention setting. Obese and
insulin resistant states are associated with intestinal
chylomicron overproduction and subsequent remnant
lipoprotein accumulation, leading to development of postprandial
dyslipidemia in the fed state. Postprandial
dyslipidemia is thought to be a major contributor of
atherogenesis and shown to be an important CVD risk factor. As intestinal
peptides (e.g.
glucagon-like-peptide 1;
GLP-1) have been shown to regulate
chylomicron output, alterations in these signaling pathways in
insulin resistant states may play a role in the development and/or progression of postprandial
dyslipidemia. Although several advances have been made in understanding postprandial
dyslipidemia in
insulin resistance and its association with CVD, several limitations remain. Although nonfasting
lipid measurements (i.e. random blood sampling) are now recommended in some countries, a more functional assessment of postprandial
lipemia involves ingestion of a high-fat meal with subsequent blood collection over a specified time period (i.e. oral fat tolerance test). However, oral fat tolerance test methodology remains largely unstandardized and reference values to interpret postprandial values remain to be accurately established. Development of standardized methodologies and
biomarker profiles for assessment of postprandial
dyslipidemia in clinical practice will enable early and accurate identification of those at risk for CVD.