Insulin Resistance and Arterial Stiffness in Healthy Adolescents and Young Adults

Diabetologia. 2012 Mar;55(3):625-31. doi: 10.1007/s00125-011-2412-1. Epub 2011 Dec 23.

Abstract

Aims/hypothesis: Increased arterial stiffness is a risk factor for adverse cardiovascular events in adults with obesity-related insulin resistance (IR) or type 2 diabetes mellitus. Adolescents with type 2 diabetes have stiffer vessels. Whether stiffness is increased in obesity/IR in youth is not known. We sought to determine if IR was a determinant of arterial stiffness in youth, independent of obesity and cardiovascular risk factors.

Methods: We measured cardiovascular risk factors, IR, adipocytokines and arterial stiffness (brachial artery distensibility [BrachD], pulse wave velocity [PWV]) and wave reflection (augmentation index [AIx]) in 343 adolescents and young adults without type 2 diabetes (15-28 years old, 47% male, 48% non-white). Individuals <85th percentile of BMI were classified as lean (n = 232). Obese individuals were grouped by HOMA index as not insulin resistant (n = 46) or insulin resistant (n = 65) by the 90th percentile for HOMA for lean. Mean differences were evaluated by ANOVA. Multivariate models evaluated whether HOMA was an independent determinant of arterial stiffness.

Results: Risk factors deteriorated from lean to obese to obese/insulin resistant (all p ≤ 0.017). Higher AIx, lower BrachD and higher PWV indicated increased arterial stiffness in obese and obese/insulin-resistant participants. HOMA was not an independent determinant. Age, sex, BMI and BP were the most consistent determinants, with HDL-cholesterol playing a role for BrachD and leptin for PWV (AIx R²= 0.34; BrachD R² = 0.37; PWV R² = 0.40; all p ≤ 0.02).

Conclusions/interpretation: Although IR is associated with increased arterial stiffness, traditional cardiovascular risk factors, especially obesity and BP, are the major determinants of arterial stiffness in healthy young people.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adiposity
  • Adolescent
  • Adolescent Development*
  • Adult
  • Blood Pressure
  • Body Mass Index
  • Brachial Artery / growth & development*
  • Brachial Artery / pathology
  • Cardiovascular Diseases / epidemiology
  • Cholesterol, HDL / blood
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Insulin Resistance*
  • Leptin / blood
  • Longitudinal Studies
  • Male
  • Obesity / blood
  • Obesity / metabolism
  • Obesity / pathology
  • Ohio / epidemiology
  • Risk Factors
  • Vascular Stiffness*
  • Young Adult

Substances

  • Cholesterol, HDL
  • Leptin