Hellenic Postprandial Lipemia Study (HPLS): A Prospective Cohort Trial on the Effect of Statins on Postprandial Hypertriglyceridemia

Introduction/Objective: Both fasting and postprandial hypertriglyceridemia are associated with atherosclerotic cardiovascular disease (ASCVD). The Hellenic Postprandial Lipemia Study (HPLS, NCT02163044) is the largest prospective cohort trial assessing the effects of statin therapy on postprandial lipemia. Methods: Individuals at high or very high risk for ASCVD were evaluated, and their characteristics were recorded at baseline (Visit 1). At Visit 2 (2-4 weeks after Visit 1) and Visit 3 (3-4 months after Visit 2), serum triglyceride (TG) levels were measured after a 12-hour fast (fTG) as well as 4 hours after the ingestion of a commercially available oral fat tolerance test meal (pTG). After Visit 2, all individuals were treated with a statin. Results and Discussion: Among 900 participants, 699 completed all 3 visits, and of these, 209 (29.9%) had an abnormal pTG response. The mean (standard deviation, SD) total- and low-density lipoprotein cholesterol concentrations were 225 (50) and 148 (46) mg/dL at Visit 1, 231 (42) and 156 (40) mg/dL at Visit 2, and 171 (28) and 101 (27) mg/dL at Visit 3. At Visit 2, the mean fTG level was 127 (45) mg/dL and pTG was 188 (73) mg/dL with a mean difference of 58 mg/dL (P<0.001). At Visit 3, the mean fTG concentration was 110 (40) mg/dL, while pTG was 140 (54) mg/dL (mean difference: 29 mg/dL; P<0.001). Fasting glucose levels had no impact on pTG response in statin-treated individuals with abnormal postprandial lipemia. Conclusion: Nearly 30% of individuals at high-/very high-risk for ASCVD had postprandial hypertriglyceridemia. Statin treatment normalized abnormal postprandial lipemia in 75.6% of participants, and decreased pTG concentration even in those with normal fTG levels.