Recent Advancements Made in the Field of Managing PPS
October 15, 2022
Elevation of Postprandial Blood Sugar and Visible Symptoms: What Can You Do to Maintain PPS Levels?
October 15, 2022
The prevalence of type 2 diabetes throughout the world has reached epidemic proportions. Traditional risk factors can no longer completely explain the risk of developing cardiovascular disease in those with diabetes. Several studies have successfully indicated postprandial metabolic derangements such as hyperglycaemia as well as hypertriglyceridaemia, which are highly exaggerated and immensely prolonged in type 2 diabetes, are key risk factors for cardiovascular disease and heart complications because they eventually lead to oxidative stress as well as endothelial dysfunction. Here, we will look at current evidence that shows that when postprandial blood sugar normal range is not maintained, there is a major risk factor for developing cardiovascular disease. Moreover, we throw light on the mechanisms that underlie this association.
PPS and Cardiovascular Disease
It is quite well recognized that those with type 2 diabetes are at an increased risk of developing atherosclerosis, which can lead to high cardiovascular disease morbidity as well as mortality. Hence, with the rise in the overall prevalence of diabetes, it is inevitable that the global burden of cardiovascular disease will increase, too. Because the so-called traditional risk factors such as hypertension, high cholesterol, smoking, and low levels of high-density lipoprotein (HDL) cholesterol cannot completely explain the excessive risk of developing cardiovascular disease in diabetic patients, there is a need to identify other risk factors.
Atherosclerosis
Two key processes that are involved in the development of atherosclerosis (which is the underlying cause when it comes to cardiovascular disease) are inflammation and activation of coagulation. Though the precise mechanisms that underlie atherogenesis are still not entirely understood, it is believed that vascular endothelial dysfunction is the starting point.
That said, only in recent times, the excessive as well as prolonged metabolic disturbances that occur in the postprandial blood sugar levels in those with type 2 diabetes have rekindled interest as potential risk factors for cardiovascular disease and heart complications.
Over the last 200 years, a significant body of evidence has accumulated that indicates a relation between postprandial dysmetabolism and the risk of developing cardiovascular disease.
Postprandial Hyperglycaemia
Several mechanisms help in keeping plasma glucose levels in healthy individuals between stringent limits, even after an intake of a high-carbohydrate meal. Dysfunction of beta-cells (for instance, disruption of the normal insulin secretion pattern) and insulin resistance lead to glucose intolerance, and both can be found fairly early in the disease process that eventually leads to type 2 diabetes.
Numerous epidemiological studies have demonstrated an association between two-hour glucose concentrations post consumption of a 75-gram glucose load (2hPG) and the development of cardiovascular disease among the general population.
A meta-analysis of twenty studies involving 95,000 individuals indicated a continual relationship between post-load glucose levels and cardiovascular-disease risk that extends into the non-diabetic range.
Another study indicated that 2hPG concentrations, even in those individuals with normal fasting glucose, were also associated with mortality, regardless of fasting plasma glucose concentrations.
Chronic hyperglycaemia has been successfully associated with impaired endothelial function. Some researchers have shown that high levels of postprandial blood glucose are accompanied by numerous alterations in the system of coagulation.
Thus, post-load or postprandial blood sugar levels have an association with an enhanced risk of cardiovascular disease. That said, a majority of epidemiological studies that addressed the contribution of post-load glucose levels to the risk of developing of cardiovascular disease failed to consider the earlier-mentioned classical risk factors, including dyslipidaemia.
These data successfully indicate that post-load glucose may not be an independent risk factor for cardiovascular disease but rather a risk-marker, which is suggestive of other underlying metabolic disturbances, including insulin resistance and dyslipidaemia, which could have an even-greater impact on the risk for cardiovascular disease.
To conclude, direct evidence of postprandial hyperglycaemia serving as an independent risk factor is not convincing. Hence, the observed association between post-load glucose excursions with cardiovascular disease can be partly explained by the presence of related cardiovascular-disease risk factors as well as insulin resistance.
Postprandial Hypertriglyceridaemia
In a typical western diet, around 40% of the energy intake is comprised of fats. When it comes to the insulin-resistant state, the eventual production of very low-density lipoprotein (VLDL) by the liver is extremely high. In combination with a reduced lipoprotein lipase activity, this results in high concentrations of triglycerides, particularly in the postprandial state.
In the year 1959, an association was reported between plasma concentrations and incident coronary heart disease. That said, the known inverse association between HDL cholesterol and triglycerides makes it challenging to demonstrate an independent association between atherosclerotic vascular disease and plasma triglyceride.
A recently concluded meta-analysis that included data of 57,000 subjects from as many as 17 studies showed that fasting triglyceride concentrations were essentially an independent risk factor for cardiovascular disease, additionally when adjusted for HDL cholesterol.
When it comes to general practice, serum lipid concentrations that include triglycerides are typically measured in the morning, after observing an overnight fast. That said, the fasting value must be considered the nadir of the 24-hour triglyceride profile and therefore could be misleadingly low.
Few years ago, numerous clinical studies have demonstrated that high postprandial triglyceride-rich lipoproteins (TRL) could be related to coronary heart disease and/or carotid artery disease in both diabetic and non-diabetic individuals.
To Sum It Up:
Historically, when it comes to diabetic individuals, primary focus was laid on hyperglycaemia; however, recent studies demonstrate the role of dyslipidaemia (especially hypertriglyceridaemia) as a risk factor for cardiovascular disease. Although presently epidemiological as well as long-term intervention studies are lacking, in vivo data convincingly demonstrates an association between postprandial TRL and indicators of cardiovascular disease. Hence, it could be stated that prolonged postprandial hypertriglyceridaemia causes an atherogenic environment in vivo. However, when it comes to postprandial hyperglycaemia, the evidence of postprandial hypertriglyceridaemia as independent in cardiovascular disease is still lacking.
References:
