Reductions in arterial stiffness with weight loss in overweight and obese young adults: Potential mechanisms
ABSTRACT Arterial stiffness decreases with weight loss in overweight/obese young adults. We aimed to determine the mechanisms by which this occurs.
We evaluated carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV) in 344 young adults (23% male, BMI 25-40 kg/m(2)) at baseline, 6, and 12 months in a behavioral weight loss intervention. Linear mixed models were used to evaluate associations between weight loss and arterial stiffness and to examine whether improvements in obesity-related factors explained these associations.
At 6 months (7% mean weight loss), there was a significant median decrease of 47.5 cm/s in cfPWV (p < 0.0001) and a mean decrease of 11.7 cm/s in baPWV (p = 0.049). At 12 months (6% mean weight loss), only cfPWV remained reduced. In models adjusting for changes in mean arterial pressure and obesity-related factors, changes in BMI (p = 0.01) and common carotid artery diameter (p = 0.003) were positively associated with change in cfPWV. Reductions in heart rate (p < 0.0001) and C-reactive protein (p = 0.02) were associated with reduced baPWV and accounted for the association between weight loss and reduced baPWV.
Weight loss is associated with reduced cfPWV independently of changes in established hemodynamic and cardiometabolic risk factors, but its association with reduced baPWV is explained by concurrent reductions in heart rate and inflammation.
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ABSTRACT: Cardiovascular disease is the leading cause of morbidity and mortality in type 2 diabetes mellitus. We evaluated the predictive ability of the recently developed body adiposity index for aortic stiffness, an intermediate endpoint of cardiovascular disease, in a cross-sectional multi-ethnic Asian type 2 diabetes mellitus cohort (N = 1408). AS was estimated using carotid-femoral pulse wave velocity measured by applanation tonometry. Body adiposity index was computed as hip circumference/(height)(1.5) - 18. Compared to body mass index, waist circumference and visceral fat area, body adiposity index displayed the weakest association with pulse wave velocity (r = 0.077, 0.096, 0.134 and 0.058, respectively; all p < 0.05). Interestingly, the relationship between measurements of obesity and pulse wave velocity was ethnic dependent - body mass index, body adiposity index, waist circumference and visceral fat area consistently predicted pulse wave velocity only in Indians but not others. In multi-variable analysis, body mass index was a significant determinant of pulse wave velocity in all ethnicities. In conclusion, body adiposity index is a weak predictor of aortic stiffness (when compared with body mass index) in Asians with type 2 diabetes mellitus. © The Author(s) 2014.Diabetes & Vascular Disease Research 12/2014; 12(2). DOI:10.1177/1479164114554609 · 3.04 Impact Factor
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ABSTRACT: Individuals with type 1 diabetes mellitus are at high risk for the development of hypertension, contributing to cardiovascular complications. Hyperglycaemia-mediated neurohormonal activation increases arterial stiffness, and is an important contributing factor for hypertension. Since the sodium glucose cotransport-2 (SGLT2) inhibitor empagliflozin lowers blood pressure and HbA1c in type 1 diabetes mellitus, we hypothesized that this agent would also reduce arterial stiffness and markers of sympathetic nervous system activity. Blood pressure, arterial stiffness, heart rate variability (HRV) and circulating adrenergic mediators were measured during clamped euglycaemia (blood glucose 4-6 mmol/L) and hyperglycaemia (blood glucose 9-11 mmol/L) in 40 normotensive type 1 diabetes mellitus patients. Studies were repeated after 8 weeks of empagliflozin (25 mg once daily). In response to empagliflozin during clamped euglycaemia, systolic blood pressure (111+/-9 to 109+/-9 mmHg, p = 0.02) and augmentation indices at the radial (-52%+/-16 to -57%+/-17, p = 0.0001), carotid (+1.3+/-17.0 to -5.7+/-17.0%, p < 0.0001) and aortic positions (+0.1+/-13.4 to -6.2+/-14.3%, p < 0.0001) declined. Similar effects on arterial stiffness were observed during clamped hyperglycaemia without changing blood pressure under this condition. Carotid-radial pulse wave velocity decreased significantly under both glycemic conditions (p <= 0.0001), while declines in carotid-femoral pulse wave velocity were only significant during clamped hyperglycaemia (5.7+/-1.1 to 5.2+/-0.9 m/s, p = 0.0017). HRV, plasma noradrenalin and adrenaline remained unchanged under both clamped euglycemic and hyperglycemic conditions. Empagliflozin is associated with a decline in arterial stiffness in young type 1 diabetes mellitus subjects. The underlying mechanisms may relate to pleiotropic actions of SGLT2 inhibition, including glucose lowering, antihypertensive and weight reduction effects.Trial registration: Clinical trial registration: NCT01392560.Cardiovascular Diabetology 01/2014; 13(1):28. DOI:10.1186/1475-2840-13-28 · 3.71 Impact Factor
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ABSTRACT: Objective To compare the long-term effects of Roux-en-Y gastric bypass (GBS) and intensive lifestyle intervention (ILI) on aortic stiffness.Methods Nonrandomized clinical trial. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV) using high-fidelity applanation tonometry.ResultsA total of 159 treatment seeking morbidly obese patients were included, 82 (54 females) in the GBS-group and 77 (48 females) in the ILI-group. Participants in the GBS-group were younger (42.0 ± 9.9 vs. 46.4 ± 10.5 years), heavier (BMI 45.7 ± 5.3 vs. 42.0 ± 4.9 kg/m2), and had lower systolic pressure (137 ± 19 vs. 145 ± 18 mm Hg) and pulse pressure (57 ± 16 vs. 65 ± 17 mm Hg), all P ≤ 0.006. Mean (SD) cfPWV at baseline was 8.6 ± 1.7 m/s in the GBS-group and 8.6 ± 1.9 m/s in the ILI-group, P = 0.959. At follow-up, mean (95%CI) weight loss was larger in the GBS-group −43.3(−46.0 to −40.7) vs. −12.1(−14.6 to −9.6)kg than in the ILI-group, P < 0.001. The mean change in cfPWV was −0.02(−0.31 to 0.27)m/s in the GBS-group and 0.03(−0.28 to 0.33)m/s in the ILI-group, both P ≥ 0.412; adjusted between-group difference (ANCOVA) 0.05(−0.40 to 0.49)m/s, P = 0.836. The adjusted regression analysis showed that weight loss was associated with increased cfPWV in the GBS-group.ConclusionGBS and ILI had no significant long-term effects on aortic stiffness in treatment-seeking morbidly obese individuals.Obesity 01/2015; 23(1). DOI:10.1002/oby.20880 · 4.39 Impact Factor