Abstract
BackgroundChronic 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.MethodsTo 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 (cfPWV)), peripheral (femoral-ankle (faPWV)), and mixed (brachial-ankle (baPWV)) 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.ResultsAfter 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 baPWV but not faPWV or cfPWV. There was a significant interaction between 6-month weight change and change in fasting insulin when predicting changes in baPWV (p < 0.001). Individuals experiencing both weight loss and insulin reductions showed the greatest improvement in baPWV.ConclusionsYoung 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.Trial registrationNCT00366990
Highlights
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
We found that the combined effects of weight loss and reduction in circulating insulin was independent of changes in other factors related to change in pulse-wave velocity [9]
Young overweight and obese adults who lower their insulin levels and lose weight over 6 months experience decreased vascular stiffness, measured by Pulse wave velocity (PWV). This improvement in vascular stiffness was greatest among individuals who experienced both weight loss and insulin reduction
Summary
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; their combined effects on arterial stiffness are poorly understood. Weight loss is associated with reductions in PWV, independent of baseline weight [5] These findings were recently replicated in the Slow Adverse Vascular Effects (SAVE) clinical trial, preliminary results from which demonstrate that a weight loss and physical activity intervention can reduce arterial stiffness in young adults with excess weight [6]. While weight loss [5] and increased insulin sensitivity [2] are individually associated with improved central arterial stiffness, their combined effects on the aorta and other arterial segments are poorly understood. Understanding the contributions of weight loss and improved insulin sensitivity to arterial stiffness will provide insight into sub-clinical vascular changes preceding and potentially contributing to complications of diabetes and hypertension
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