The impact of postprandial lipemia in accelerating atherothrombosis

Several clinical studies have shown that the magnitude and duration of post prandial lipemia is positively related to the pathogenesis and progression of coronary heart disease. Postprandial lipid metabolism refers to the seri es of metabolic events that occur following the ingestion of a meal contain ing fat. Dietary fat is principally composed of triacylglycerol, postprandi al lipaemia therefore being characterized by an increase in plasma triacylg lycerol concentration. This review will describe the nature of the postpran dial response and show the direct and indirect pro-atherogenic effects of t riacylglycerol-rich lipoprotein metabolism. An elevated postprandial lipemi c response precipitates a number of adverse metabolic events, including the production of atherogenic chylomicron remnants, the formation of the highl y atherogenic small, dense low-density lipoprotein particles, and a reducti on in the concentration of the cardioprotective high-density lipoprotein fr action. Postprandial lipemia also interacts with the process of thrombosis, in that an elevated postprandial triacylglycerol-rich lipoprotein concentr ation has the ability to activate the coagulation factor VII and plasminoge n activator inhibitor. In the light of the potential impact of an elevated postprandial lipemia on atherothrombosis, the genetic determinants of the m agnitude of the postprandial response will be identified. Finally, the nutr itional factors that modulate the postprandial response will also be discus sed. (C) 2000 Lippincott Williams & Wilkins.