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The correlation of triglyceride and glucose tolerance with cardiovascular outcomes in patients with stable coronary artery disease: The Homburg Cream and Sugar study (HCS)

Hot Line I - Cardiovascular risk and complications

Paris, France, 28 August: The Homburg Cream and Sugar (HCS) study was designed to determine whether the measurement of postprandial triglyceride in addition to the assessment of glucose tolerance and traditional risk factors might improve the prediction of cardiovascular events.
Prevention


To facilitate the study, an oral metabolic test protocol was developed to assess triglyceride and glucose tolerance prospectively. The test consisted of an oral fat load (250 ml cream drink containing 75 g fat) followed by a glucose drink (250 ml water with 75 g glucose) three hours later. (Patients with medical treatment for diabetes received only the cream drink.) Two sets of measurements were taken: first, fasting and postprandial triglyceride (TG) concentrations; and second, insulin concentrations and glucose tolerance.

This sequential testing was performed in 514 consecutive patients with stable coronary artery disease (CAD) undergoing coronary angiography. Eighteen months later they were followed-up for assessment of the primary composite endpoint of cardiovascular death or hospitalisation for cardiovascular events.

Results of the study showed that the combined testing of postprandial glucose and triglyceride tolerance is feasible in clinical practice. However, a number of specific conclusions emerged, notably that in the total cohort postprandial TG concentrations did not correlate with the number of primary endpoint events; fasting TG levels were found to be predictive, but this association was lost in multivariate analysis.

However, both fasting and postprandial TG levels were strongly correlated with glucose metabolism: patients with normal glucose tolerance had lower fasting TGs and a lower absolute postprandial TG increase than those with impaired glucose metabolism (although the mean relative TG increase was comparable). Thus, in patients with normal glucose tolerance both fasting and postprandial TG levels were identified as independent markers for cardiovascular outcomes. In those with impaired glucose tolerance, however, postprandial TG levels did not predict outcomes.

"This is the first prospective study to assess postprandial triglycerides and glucose tolerance at the same time in a representative cohort of patients with coronary artery disease," said investigator Professor Ulrich Laufs from the from Saarland University Hospital, Homburg, Germany. "While the combined sequential test protocol did allow the prediction of cardiovascular outcomes in the total cohort of patients with CAD, we did find that in CAD patients with diabetes and impaired glucose tolerance, absolute fasting and postprandial TG levels were high but not independently predictive of cardiovascular outcomes. In contrast, in patients with CAD and normal glucose tolerance, both fasting and - with superior risk prediction - postprandial TG concentrations were independent markers for cardiovascular outcomes."

As background to the study Laufs noted that serum TG concentrations have long been associated with the risk of CVD. However, the extent of that association was unclear and inconsistent in study results. "It is a matter of current debate whether serum triglycerides represent an independent risk factor for CVD," he said, "and how these values might be interpreted in secondary prevention of CVD. The HCS study was set up to clarify this."

References

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2011.

Hot Line I - Cardiovascular risk and complications
Prospective evaluation of post-prandial triglycerides and cardiovascular events in patients with coronary artery disease

Edited by the ESC from material supplied by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the investigator.

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 68,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About ESC Congress 2011
ESC Congress 2011 will take place from 27 to 31 August at the Parc des Expositions - Paris Nord Villepinte, France. Information on the scientific programme is available here. More information on ESC Congress 2011 is available from the ESC Press Office or contact us at press@escardio.org