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01.12.2012 | Original investigation | Ausgabe 1/2012 Open Access

Cardiovascular Diabetology 1/2012

Effects of weight loss and insulin reduction on arterial stiffness in the SAVE trial

Cardiovascular Diabetology > Ausgabe 1/2012
Timothy M Hughes, Andrew D Althouse, Nancy A Niemczyk, Marquis S Hawkins, Allison L Kuipers, Kim Sutton-Tyrrell
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-2840-11-114) contains supplementary material, which is available to authorized users.

Competing interests

The authors have no competing interests to report. Timothy M. Hughes, Andrew D. Althouse, Marquis Hawkins and Allison Kuipers were supported by an NHBLI training grant to the University of Pittsburgh (T32HL083825). Nancy A. Niemczyk was supported by an NICHD training grant to the University of Pittsburgh (T32HD0055162-04). Kim Sutton-Tyrrell is the principle investigator of SAVE, supported by NHBI (R01 HL077525-01A2).

Authors’ contributions

Timothy Hughes and Andrew Althouse were responsible for the design, data analysis and drafting of the manuscript. Marquis Hawkins, Allison Kuipers, Nancy A. Niemczyk and Kim Sutton-Tyrrell contributed to the drafting and editing of the manuscript. Kim Sutton-Tyrrell was the primary investigator of the SAVE trial (NCT00366990). All authors read and approved the final manuscript.



Chronic arterial stiffness contributes to the negative health effects of obesity and insulin resistance, which include hypertension, stroke, and increased cardiovascular and all-cause mortality. Weight loss and improved insulin sensitivity are individually associated with improved central arterial stiffness; however, their combined effects on arterial stiffness are poorly understood. The purpose of this study was to determine how insulin levels modify the improvements in arterial stiffness seen with weight loss in overweight and obese young adults.


To assess the effects of weight loss and decreased fasting insulin on vascular stiffness, we studied 339 participants in the Slow the Adverse Effects of Vascular Aging (SAVE) trial. At study entry, the participants were aged 20–45, normotensive, non-diabetic, and had a body-mass index of 25–39.9 kg/m2. Measures of pulse wave velocity (PWV) in the central (carotid-femoral (cf PWV)), peripheral (femoral-ankle (fa PWV)), and mixed (brachial-ankle (ba PWV)) vascular beds were collected at baseline and 6 months. The effects of 6-month change in weight and insulin on measures of PWV were estimated using multivariate regression.


After adjustment for baseline risk factors and change in systolic blood pressure, 6-month weight loss and 6-month change in fasting insulin independently predicted improvement in ba PWV but not fa PWV or cf PWV. There was a significant interaction between 6-month weight change and change in fasting insulin when predicting changes in ba PWV (p < 0.001). Individuals experiencing both weight loss and insulin reductions showed the greatest improvement in ba PWV.


Young adults with excess weight who both lower their insulin levels and lose weight see the greatest improvement in vascular stiffness. This improvement in vascular stiffness with weight loss and insulin declines may occur throughout the vasculature and may not be limited to individual vascular beds.

Trial registration

Additional file 1: Figure S1. Proportion of subjects experiencing a decrease in baPWV of ≥50 cm/sec by insulin- and weight-loss groups in the SAVE trial. This more clearly shows that a greater proportion of the “Weight Decrease and Insulin Decrease” had a baPWV decrease of 50 cm/sec (*Note: I chose 50 as somewhat of an arbitrary cutoff, but it seems to provide a decent # of patients in all categories and also will appeal to readers that just like round numbers). There is also a statistically significant difference between the groups in a global test (p = 0.015), so it might be appealing to present this figure with a p-value. (DOC 78 KB)
Authors’ original file for figure 1
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