La lipemia postprandiale: dai risultati sperimentali all’intervento terapeutico = Postprandial lipemia: from experimental evidences to therapeutic treatment

Elevated non-fasting triglycerides levels and remnant lipoprotein cholesterol content are considered independent biomarkers for cardiovascular risk assessment; indeed, genetic approaches on large populations have suggested their causal role in the development of atherosclerotic process, corroborating previous experimental evidences from in vitro studies and animal models. On top of data from basic and clinical research, it should be acknowledged that a person spends the majority of its time in postprandial phase; thereby lipid metabolism is a dynamic condition in which enzymatic activities, the structure, the half life and the content of circulating lipoproteins are continuously changing. Indeed, it is largely known that these parameters determine the atherogenicity of the same lipoproteins, which, during postprandial phase, activate key pathways of the atherosclerotic process. The elevated content in triglycerides and cholesterol in circulating lipoproteins, therefore, favor the diagnosis of “atherogenic dyslipidaemia”. Considering these aspects, it is easy to understand that this condition is not only significant for the clinical phenotype, but also for the response to pharmacological treatment and, finally, for the cardiovascular risk. Treatments of clinical use for dyslipidaemia are presently fibrates, niacin and omega-3. Both randomized trials and studies of postprandial kinetic confirmed their efficacy, on top of statins, even though contrasting data are not lacking, especially in high-risk patients. New therapeutic perspectives are therefore needed and studies of postprandial phase are useful to understand the physio-pathological mechanisms determining atherogenic dyslipidaemia. In the meanwhile, clinicians can obtain useful information to set more adequate therapies for each patient.