What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Obesity and Type 2 Diabetes (n=612). Intervention: Increased arterial stiffness (Global Stiffness Index ≥ 4) vs. Compliant arteries (Global Stiffness Index < 4). Primary outcome: Diastolic function (E/A ratio) (p=<0.01).

November 29, 2021Open Access

Increased Arterial Stiffness Is Associated With Reduced Diastolic Function in Youth With Obesity and Type 2 Diabetes

Q: What are the key findings of this study?

Increased arterial stiffness in youth was independently associated with reduced diastolic function, including a lower E/A ratio (1.76 vs 1.99), regardless of traditional cardiovascular risk factors.

NMNicolas MadsenThe University of Texas Southwestern Medical Center JHJessica HaleyUniversity of California, San Diego RMRyan A. MooreCincinnati Children's Hospital Medical Center

Key Result

Increased arterial stiffness in youth was independently associated with reduced diastolic function, including a lower E/A ratio (1.76 vs 1.99), regardless of traditional cardiovascular risk factors.

Study Design

Type

Cross-Sectional (n=612)

Structured PICO

Does increased arterial stiffness reduce diastolic function in youth with obesity and type 2 diabetes?

Population

612 youth aged 10 to 24 years (65% female), including lean, obese, and type 2 diabetic participants, evaluated cross-sectionally to assess the relationship between arterial stiffness and diastolic function.

Exposure

Stiff arteries (defined as Global Stiffness Index > 4 based on seven arterial stiffness parameters)

Comparator

Compliant arteries (defined as Global Stiffness Index ≤ 4)

Outcome

Diastolic function measured by echocardiography (including E/A ratio, e'/a' ratio, E/e' ratio, and left atrial diameter indexed to height)surrogate

Main Result

Absolute Event Rate: 1.76% vs 1.99%

p-value: p=<0.01

Limitations

Cross-sectional design precludes determining causality or the temporal sequence of arterial stiffness and diastolic dysfunction.
Large proportion of obese and T2DM subjects may limit generalizability to other populations.
Duration of obesity and T2DM could not be assessed.
Potential unmeasured confounders such as physical activity and fitness levels.
Specialized equipment and expertise required for stiffness measurement may limit clinical applicability.

Abstract

Background: Increased arterial stiffness is associated with diastolic dysfunction in adults. Data in youth are lacking, so we examined the impact of arterial stiffness on diastolic function in youth. Methods: We obtained diastolic function and augmentation index, pulse wave velocity, brachial artery distensibility, and carotid stiffness on 612 youth 10–24 years, 65% female, 38% normal weight, 36% obese, and 26% with type 2 diabetes mellitus (T2DM). Participants were classified as compliant (C) vs. stiff (S) arteries based on seven arterial stiffness parameters [Global Stiffness Index (GSI), S = GSI 4). Mean differences in covariates were evaluated by Student's t -tests. A stepwise regression analysis was performed to determine if GSI was an independent predictor of diastolic function. Results: Lower diastolic function and more adverse cardiovascular disease (CVD) risk factors were present in the S group ( n = 67) than the C group ( n = 545) ( p 0.001). Covariates that were associated with diastolic dysfunction were higher GSI, male sex, higher body mass index (BMI), and systolic blood pressure (SBP) z -score ( R 2 = 0.18 to 0.25; p ≤ 0.05). Conclusion: Adverse diastolic function is seen in youth with increased arterial stiffness independent of CVD risk factors. Interventions to improve arterial stiffness prior to clinical onset of diastolic dysfunction are needed to prevent development of heart failure.

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