Elevated estimated pulse wave velocity and the risk of type 2 diabetes in non-obese young adults: a longitudinal cohort study

BACKGROUND: Arterial stiffness (AS), measured by estimated pulse wave velocity (ePWV), is associated with a higher risk of cardiovascular diseases and type 2 diabetes mellitus (T2DM) in older and obese individuals. However, the role of AS as an early predictor of T2DM in non-obese, young adults remains underexplored. Identifying alternative predictors like AS is crucial for detecting diabetes onset in non-obese and younger populations who may not exhibit traditional risk factors such as high body mass index (BMI). METHODS: A cohort of 9,543 non-obese participants aged 18-49 years from the NAGALA dataset was followed over a median period of 6.3 years. Cox proportional hazard models were used to assess the association between ePWV and T2DM risk, adjusting for multiple covariates, including age, sex, BMI, alcohol consumption, smoking status, and metabolic markers. Subgroup analyses were conducted to evaluate the stability of the association across different groups. Additionally, ROC curve analysis was performed to assess the predictive power of ePWV in T2DM risk. RESULTS: A total of 110 participants developed T2DM during follow-up. Elevated ePWV was associated with increased T2DM risk (HR 1.36, 95% CI: 1.05-1.75, P = 0.018), even after adjusting for multiple covariates. The ROC analysis demonstrated that the inclusion of ePWV in the predictive model (sex + BMI + diastolic blood pressure (DBP) + ePWV) improved the predictive power for T2DM risk, with AUC values increasing in comparison to the model using sex, BMI and DBP alone (10-year AUC: 0.734 vs. 0.679, P = 0.016). Subgroup analyses showed that the association between ePWV and T2DM risk was consistent across sex, age, alcohol consumption, and smoking status. CONCLUSIONS: Elevated ePWV independently correlates with a higher risk of T2DM in non-obese young adults. This study investigates the relationship between elevated arterial stiffness (AS), measured by estimated pulse wave velocity (ePWV), and the risk of developing type 2 diabetes mellitus (T2DM) in non-obese young adults. While AS has been linked to higher T2DM risk in older or obese individuals, this study uniquely focuses on non-obese young adults, a group not typically associated with high diabetes risk. By analyzing data from over 9,500 participants, the research found that even in individuals with a normal body mass index (BMI), higher ePWV is significantly associated with an increased risk of T2DM. This suggests that measuring ePWV could help detect early diabetes risk in people who may not exhibit traditional risk factors, such as high BMI. The findings highlight the importance of vascular health in prevention of diabetes and propose ePWV as a potential tool for early detection in clinical practice.