T2D, Obesity May Accelerate Vascular Aging in Teens

May 14, 2020
Gianna Melillo
Gianna Melillo

Gianna is an assistant editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.

Teenagers with obesity, type 2 diabetes (T2D), or high blood pressure may have a higher risk of experiencing premature vascular aging compared with teens without the conditions, according to a study published in the Journal of the American Heart Association.

Teenagers with obesity, type 2 diabetes (T2D), or high blood pressure may have a higher risk of experiencing premature vascular aging compared with teens without the conditions, according to a study published in the Journal of the American Heart Association.

Obesity, T2D, and high systolic blood pressure (SBP) are major risk factors for heart attacks and strokes. Over the course of 5 years, researchers analyzed atherosclerosis, or arterial narrowing, among 141 teens with normal weight, 156 with obesity, and 151 with T2D. When the study began, the average participant age was 17.6.

Body mass index (BMI) percentiles were obtained from CDC growth charts. Researchers defined normal weight as BMI percentiles greather than 5th to less than 85th and obesity as the 95th BMI percentile or greater.

Using high‐resolution B‐mode carotid ultrasounds, researchers measured carotid intima‐media thickness (cIMT) bilaterally in the common, internal, and bulb of the carotid artery. Arterial stiffness was measured via carotid‐femoral pulse wave velocity (PWV) and Aix, or “the pressure difference between the primary [main outgoing wave] and the reflected wave of the central arterial waveform, expressed as a percentage of the central pulse pressure.” All measurements were taken at baseline and after 5 years.

After adjusting for race, age, and other variables, researchers determined that male sex was associated with greater positive change in bulb cIMT (0.038 mm; 95% CI, 0.010-0.065 mm; P = .008), carotid incremental elastic modulus (cIEM) (188.16 mm Hg; 95% CI, 100.97-275.35 mm Hg; P < .001) and reduced Aix (−2.76%; 95% CI, −5.27% to −0.25%; P = .031) compared with female sex. Nonwhite race was also associated with greater positive change in bulb cIMT, common cIMT, and Aix compared with white participants.

Participants with obesity and individuals with T2D demonstrated greater positive change in common cIMT, bulb cIMT, internal cIMT, and PWV carotid-femoral compared with normal-weight participants and individuals without diabetes. However, compared with those with obesity, participants with T2D exhibited greater change in bulb cIMT (0.04 mm; 95% CI, 0.01-0.07 mm; P = .007), Aix (4.83%; 95% CI, 2.29-7.36; P < .001), and PWV carotid&#8208;femoral (0.36 m/sec; 95% CI, 0.09-0.63 m/sec; P = .009).

“Our study demonstrates that the slow changes in blood vessels that lead to the development of atherosclerosis begins early in life,” said Justin R. Ryder, PhD, a lead author of the study.

Interestingly, effects of different risk factors appear to be location-specific for cIMT. According to researchers, “SBP was associated with adverse thickening in the common, bulb, and internal carotid, while the effects of obesity and T2D were only associated with higher cIMT in the common carotid after accounting for the effects of SBP.”

Researchers expressed surprise that participants with higher SBP had a very similar risk to those with obesity or T2D for thicker and stiffer blood vessels over time.

One limitation of the study is the use of noninvasive measures as opposed to hard cardiovascular outcomes. In addition, relatively low frequency of follow-up visits limited investigators’ capability to evaluate changes throughout the study period.

“Although T2D is treated aggressively in the US, obesity needs to be treated just as vigorously because it has the same increased risk for premature aging of the blood vessels, which is an early sign of cardiovascular dysfunction and a precursor to cardiovascular diseases in adulthood,” Ryder said.

Reference:

Ryder JR, Northrop E, Rudser KD, et al. Accelerated early vascular aging among adolescents with obesity and/or type 2 diabetes mellitus. J Am Heart Assoc. Published online May 6, 2020. doi:10.1161/JAHA.119.014891