The online version of this article (doi:10.1186/1475-2840-11-114) contains supplementary material, which is available to authorized users.
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).
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.
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)12933_2012_516_MOESM1_ESM.doc
Authors’ original file for figure 112933_2012_516_MOESM2_ESM.pdf
Park JS, Nam JS, Cho MH, Yoo JS, Ahn CW, Jee SH, Lee HS, Cha BS, Kim KR, Lee HC: Insulin resistance independently influences arterial stiffness in normoglycemic normotensive postmenopausal women. Menopause. 2010, 17 (4): 779-784. PubMed
Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, Havlik R, Lakatta EG, Spurgeon H, Kritchevsky S, et al: Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation. 2005, 111 (25): 3384-3390. 10.1161/CIRCULATIONAHA.104.483628. CrossRefPubMed
Dengo A, Dennis E, Orr J, Marinik E, Ehrlich E, Davy B, Davy K: Arterial destiffening with weight loss in overweight and obese middle-aged and older adults. Hypertension. 2010, 55 (4): 885-861. CrossRef
Sutton-Tyrrell K, Barinas-Mitchell K, Kinzel L, Woodard G, Lloyd K, Cooper J, Brooks M, Kriska A, Conroy M: The Effects of a Behavioral Lifestyle and Sodium Intervention on Aortic Pulse Wave Velocity, a Measure of Vascular Health: Primary Results of the SAVE Clinical Trial. American Heart Association Cardiovascular Disease Epidemiology and Prevention Scientific Sessions 2011. 2011, Atlanta, GA
Cooper J, Buchanich J, Youk A, Brooks M, Barinas-Mitchell E, Conroy M, Sutton-Tyrrell K: Reductions in arterial stiffness with weight loss in overweight and obese young adults: potential mechanisms. Atherosclerosis. 2012, 223 (2): 485-490. 10.1016/j.atherosclerosis.2012.05.022. PubMedCentralCrossRefPubMed
Njoroge J, El Khoudary S, Fried L, Barinas-Mitchell E, Sutton-Tyrrell K: High urinary sodium is associated with increased carotid intima-media thickness in normotensive overweight and obese adults. Am J Hypertension. 2011, 24 (1): 70-76. 10.1038/ajh.2010.113. CrossRef
Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker-Boudier H: Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006, 27 (21): 2588-2605. 10.1093/eurheartj/ehl254. CrossRefPubMed
Warnick G, Albers J: Heparin-Mn2+ quantitation of high density lipoprotein cholesterol: an ultrafiltration procedure for lipemic samples. Clin Chem. 1978, 24 (6): 900-904. PubMed
Friedewald W, Levy R, Fredrickson D: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972, 18 (6): 499-502. PubMed
Yue W, Lau K, Siu C, Wang M, Yan G, Yiu K, Tse H: Impact of glycemic control on circulating endothelial progenitor cells and arterial stiffness in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2011, 20 (113): Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258289.
Gómez-Marcos MA R-RJ, Patino-Alonso MC, Agudo-Conde C, Gómez-Sánchez L, Rodríguez-Sánchez E, Martín-Cantera C, García-Ortiz L: Relationship between intima-media thickness of the common carotid artery and arterial stiffness in subjects with and without type 2 diabetes: a case-series report. Cardiovasc Diabetol. 2011, 10 (1): Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034668/.
Garcia-Ortiz L, Ramos-Delgado E, Recio-Rodriguez J, Agudo-Conde C, Martínez-Salgado C, Patino-Alonso M, Rodriguez-Sanchez E, Gomez-Marcos M: Peripheral and central arterial pressure and its relationship to vascular target organ damage in carotid artery, retina and arterial stiffness. Development and validation of a tool. The Vaso risk study. BMC Publ Health. 2011, 11 (266): Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096907/.
Pohjantähti-Maaroos HPA, Kankkunen P, Laitinen R, Husgafvel S, Oksanen K: Circulating oxidized low-density lipoproteins and arterial elasticity: comparison between men with metabolic syndrome and physically active counterparts. Cardiovasc Diabetol. 2010, 9 (41): Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931500/.
Samaras KVA, Lee PN, Jenkins A, Botelho NK, Bakopanos A, Lord RV, Hayward CS: Reduced arterial stiffness after weight loss in obese type 2 diabetes and impaired glucose tolerance: the role of immune cell activation and insulin resistance. Diab Vasc Dis Res. 2012, 0 (0): 1-9. Retrieved from http://dvr.sagepub.com/content/early/2012/04/24/1479164112443375.long.
- Effects of weight loss and insulin reduction on arterial stiffness in the SAVE trial
Timothy M Hughes
Andrew D Althouse
Nancy A Niemczyk
Marquis S Hawkins
Allison L Kuipers
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II