LPL and Insulin resistance: The mechanism of hepatic VLDL-TG secretion and LPL-mediated clearance of TG-rich lipoproteins are greatly influenced by insulin resistance and hyperinsulinemia.51, 52, 53 The concentrations of PHTG and fasting TG become elevated from increased hepatic VLDL-TG secretions and inhibited LPL-mediated clearance.