Postprandial implications in cardiovascular disease and potential markers to develop new therapies

An unbalanced diet significantly raises the risk of various chronic diseases and cancers, contributing to increased morbidity and mortality globally. Today, the link between metabolic status and cardiovascular disease is well established. Disruptions in glucose and lipid homeostasis, particularly postprandial hyperglycemia and hyperlipidemia are key risk factors for cardiovascular conditions. These postprandial metabolic disturbances promote atherosclerosis and cardiovascular injury, primarily by triggering endothelial dysfunction. Lifestyle interventions play a pivotal role, and pharmacological treatments aimed at controlling lipid and glucose levels generally lead to improvements in both fasting and postprandial states. However, further research is necessary to establish reference values for biomarkers of postprandial dysmetabolism and to evaluate their clinical relevance. Individuals who exhibit a mismatch between fasting and postprandial levels of glucose and triglycerides, namely, those with normal or mildly elevated fasting levels but exaggerated postprandial responses, may represent a subgroup at heightened and potentially modifiable risk for both microvascular and macrovascular complications. Validating biomarkers of postprandial dysmetabolism could offer valuable clinical tools for improved risk assessment and personalized therapeutic strategies. This review summarises the unique physiology of triglyceride-rich lipoprotein metabolism after meals and the disruptions that can foster cardiovascular complications. Given the scarcity of targeted therapies, it also discusses emerging treatment candidates and their underlying mechanisms.