Postprandial lipoprotein clearance in type 2 diabetes: fenofibrate effects.

Lipoprotein abnormalities [mainly high levels of very-low-density lipoprotein triglycerides (TG) and low levels of high-density lipoprotein cholesterol] increase the risk of cardiovascular disease in Type 2 diabetic patients. Moreover, only fasting TG and central obesity appear to independently predict mortality from CAD in glucose-intolerant and diabetic subjects. It is noteworthy that fasting lipid levels in these patients are often relatively unaffected, and that plasma TG may remain < 2 g/l, the cutoff point currently considered to define moderate hypertriglyceridemia. Our study of postprandial lipaemia shows that lipid intolerance (a greater increase of postprandial TG and a slower return towards basal levels) was almost always present in these patients, enabling us to detect atherogenic changes in plasma lipoproteins. Preliminary results indicate that fenofibrate treatment in Type 2 diabetes under optimised metabolic control improves not only fasting lipid levels but also postprandial lipaemia and associated abnormalities in lipoprotein levels and composition.