Obesity and Type 2 Diabetes Predispose Adolescents to Accelerated Vascular Aging

Adolescents and young adults with obesity or type 2 diabetes (T2D) are at increased risk for progression of cardiovascular risk factors and accelerated early vascular aging, according to study results published in the Journal of the American Heart Association.

Previous studies have reported an association between cardiovascular risk factors and higher carotid intima-media thickness (cIMT), arterial stiffness, and fatty lesions and streaks. However, limited data are available on the key risk factors associated with accelerated early vascular aging.

The 5-year longitudinal study included adolescents with normal weight, obesity, and/or T2D and aimed to identify factors associated with accelerated subclinical atherosclerosis.

The study cohort included 448 adolescents and young adults (mean age, 17.6 years; 35% male) who completed baseline and 5-year follow-up visits. Within the cohort, 141 individuals had normal weight, 156 had obesity, and 151 had a prior diagnosis of T2D at baseline.

Primary measures used for early vascular aging included measures of vascular structure (cIMT: common, internal, and bulb) and arterial stiffness (carotid-femoral pulse wave velocity [PWV] and augmentation index).

Risk factors for accelerated early vascular aging included age, male sex, high systolic blood pressure, and nonwhite race, each appearing to be key independent risk factors for changes in cIMT and arterial stiffness. Male sex was associated with greater positive changes in bulb cIMT (0.038 mm) and reduced augmentation index (-2.76%) compared with female sex. Age was associated with greater changes in bulb cIMT (0.028 mm), internal cIMT (0.029 mm), and augmentation index (3.68%).

Compared with normal weight, obesity and T2D were linked to greater positive changes in common cIMT (0.05 and 0.05 mm, respectively), bulb cIMT (0.02 and 0.06 mm, respectively), and internal cIMT (0.03 and 0.04 mm, respectively), as well as in carotid-femoral PWV (0.38 and 0.74 m/s, respectively). In addition, compared with individuals with normal weight, those with T2D had a greater positive change in augmentation index (4.67%; P <.05 for all comparisons).

Compared with adolescents with obesity, those with T2D had greater changes in bulb cIMT (0.04 mm), augmentation index (4.83%), and carotid-femoral PWV (0.36 m/s; P <.05 for all comparisons).

Higher baseline systolic blood pressure was associated with greater positive change in common cIMT (0.007 mm), bulb cIMT (0.009 mm), internal cIMT (0.008 mm), and carotid-femoral PWV (0.066 m/s; P <.05 for all comparisons).

The study had several limitations, including the use of noninvasive measures as opposed to hard cardiovascular outcomes, as well as a relatively low number of follow-up visits.

“These longitudinal data collected over a 5-year time period support the hypothesis that adolescents and young adults with obesity and/or type 2 diabetes experience accelerated early vascular aging evidenced by changes in subclinical vascular markers compared to normal weight,” concluded the researchers.

Disclosure: Multiple study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Ryder J, Northrop E, Rudser K, et al. Accelerated cardiovascular aging among adolescents with obesity and/or type 2 diabetes [published online May 6, 2020]. J Am Heart Assoc. doi:10.1161/JAHA.119.014891