Abstract P412: Increased Forward and Backward Arterial Wave Reflections Are Found in Adolescents With Obesity or Obesity-Related Type 2 Diabetes Mellitus

Abstract

Introduction: Pulse wave analysis provides an estimation of central (aortic) pressure and arterial wave reflections which relate to LV dysfunction and risk of CV events in adults. Recent adult studies suggest separation of the forward and backward waves may provide improved risk stratification for CV events. Data in youth are lacking. Hypothesis: We hypothesized that a significant difference in arterial wave reflections would be identified in young subjects with adverse CV risk factors. Methods: Vital signs, fasting lipids, glucose, insulin, HbA1c, and CRP were obtained in 551 patients aged 10-24 years in a study comparing vascular health among lean (L= 199), obese (O=173) and subjects with type 2 diabetes (T=179). Wave separation analyses were performed on pressure tracings obtained from radial artery tonometry. Group differences in CV risk factors and wave reflections were assessed using ANOVA. General linear models were constructed to elucidate independent predictors of wave reflections. Results: A more adverse CV risk profile was found in O and T subjects compared to L (higher BMI, SBP, DBP, LDL, TG, CRP, lower HDL in O and T vs L; all p≤0.0003). The T group had higher glucose, insulin, and HbA1c compared to the L and O groups (all p≤0.0001). The forward pulse wave amplitude (Pf) and the backward pulse wave amplitude (Pb) were significantly higher (P<0.0001) in the O and T groups compared to the L subjects (figure). The independent determinants of Pf included age, sex, waist-to-hip ratio (WHR), height, SBP, DBP, and HR (R2=0.24, p<0.0001). Independent determinants of Pb included group, WHR, SBP, HR, and log insulin (R2=0.43, p<0.0001). Conclusions: Adolescents and young adults with obesity and T2DM have altered forward and backward arterial wave reflections compared to lean controls related to adiposity, BP, and insulin levels. These new parameters may be useful in risk stratifying patients with adverse cardiovascular risk factors.