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: AbstractObjective In adults with arterial hypertension, measuring arterial stiffness by pulse wave velocity (PWV) can determine the extent of cardiovascular subclinical organ damage. PWV has independent predictive value for cardiovascular events, but there are currently no recommendations for measuring PWV in children. In addition, central systolic blood pressure (cSBP) strongly reflects vascular changes. The aim of this study was to establish percentiles for cSBP and PWV in children and adolescents to evaluate and classify altered vascular function in youths. Methods and Results We measured PWV and cSBP with an oscillometric device with inbuilt ARCSolver-algorithm (estimated by using the brachial waveform) and calculated smoothed reference percentiles for 1445 children and young adults (49.5% female;13.41±2.80 years, range 8-22 years; PWV 4.67±0.34 m/s; cSBP 100.7±8.9 mmHg) using the LMS-method based on age and height. PWV and cSBP increased with age and height, but slightly differently for girls and boys, possibly reflecting different growth patterns. Between 8-21 years, PWV increased from 4.29±0.32 to 4.98±0.33 m/s in girls and from 4.27±0.18 to 5.22±0.46 m/s in boys; while, girls showed a minor increase in cSBP (91.2±7.5 to 109.1±8.6 mmHg). The cSBP in boys ranged from 90.0±5.8 to 110.5±9.6 mmHg with a more pronounced increase between 14-17 years. Conclusion These percentiles for PWV and cSBP can help define arterial stiffness in youths and contribute to risk stratification for cardiovascular disease. For example, in children with prehypertension or isolated systolic hypertension, PWV and cSBP can provide additional information about the function of the vascular system, thereby strengthening intervention strategies.Atherosclerosis 01/2015; 238(1):9-16. · 3.71 Impact Factor
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ABSTRACT: Objective Type 2 diabetes (T2DM) among the young population has become a serious concern globally, presumably due to the rising trend of obesity. Compared to other forms of diabetes, young-onset T2DM experiences more cardiovascular events and other vascular complications although the underlying mechanisms remain largely unknown. Increased arterial stiffness is a hallmark of vasculopathy. We aim to study the clinical and metabolic determinants of arterial stiffness in a cohort of multi-ethnic Asians with young-onset T2DM. Methods 179 subjects with T2DM onset age below 30 years old were selected in this cross sectional study. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV). Results PWV was correlated with age, duration of diabetes, systolic blood pressure, alanine aminotransferase, urinary albumin-to-creatinine ratio (ACR) and eGFR in bivariate correlation analysis. However, PWV was only significantly correlated with body mass index (BMI), waist circumference, urinary ACR and eGFR after adjustment for age. Overweight individuals with young-onset T2DM had significantly higher PWV levels compared to their lean counterparts (7.3 ± 2.4 m/s vs 6.4 ± 2.3 m/s, p = 0.072 and p < 0.0001 without and with adjustment for age, respectively). Multivariable regression models revealed that age, BMI, eGFR and usage of insulin were independently associated with PWV. These 4 variables explained 35.5% variance in PWV levels. Conclusion Age, BMI, renal function and insulin usage are the main determinants of PWV levels in Asians with young-onset T2DM. Notably, obesity is a modifiable determinant of arterial stiffness independent of high blood pressure, dyslipidemia and hyperglycemia in this population.Atherosclerosis 10/2014; 236(2):286–291. · 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 08/2014; · 4.39 Impact Factor