Postprandial lipemia in diabetic men during hypolipemic therapy

INTRODUCTION: Mechanisms underlying postprandial lipemia in various pathological states remain to be elucidated. OBJECTIVES: The aim of the study was to evaluate lipid homeostasis in men with type 2 diabetes mellitus (DM) after a standard meal. Moreover, the effect of short-term hypolipemic therapy on postprandial lipemia was assessed. PATIENTS AND METHODS: Twenty-six men with DM aged 53 +/-6.7 years, 27 patients with hyperlipemia and no DM (asymptomatic hyperlipemia - AH) and 60 normolipemic subjects aged 46 +/-11 years were included in the study. Treatment with simvastatin (20 mg/d) or fenofibrate (267 mg/d) was initiated in all DM patients due to fasting hyperlipemia, and in the AH group. Blood samples were drawn in the fasting state and 3 h after a meal at three time points, i.e. at baseline, after 6 and 12 weeks of treatment. Triglycerides (TG), glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), HDL2-C, and HDL3-C were assayed by routine laboratory tests; apolipoproteins A and B by immunoturbidimetry, and high-sensitivity C-reactive protein (hsCRP) by immunonephelometry. RESULTS: In men with DM, changes in triglycerides induced by a meal (140 +/-68.0 mg/dl) were higher compared to normolipemic men (62.1 +/-52.5 mg/dl, p <0.001) or AH subjects (76.3 +/-80 mg/dl, p <0.05). There were no linear correlations between the levels of TG (or HDL cholesterol) and HDL3-C, or between TG and hsCRP in the DM group. Hypolipemic treatment decreased fasting lipid and hsCRP levels, significantly reduced postprandial lipemia (p <0.001) and restored some correlations between lipid variables observed in the control group, but not those with hsCRP. CONCLUSIONS: Type 2 DM is associated with increased postprandial lipemia and abnormal lipid homeostasis. Lipid intolerance detected in a postprandial lipemia test may be an indication for hypolipemic therapy.