OBESITY REMAINS A MAJOR RISK FACTOR ASSOCIATED WITH VASCULAR STIFFENING IN TYPE 2 DIABETES

Abstract

Objective: Obesity is a modifiable risk factor for cardiovascular disease. Associations between body mass index (BMI) and vascular stiffness have been described previously, and weight loss has been found to improve vascular health. Despite this, obesity remains a major health issue in people with Type 2 diabetes (T2D). Design and method: The Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria (PRIORITY) study is a prospective stratified clinical trial assessing prediction of progression from normo to microalbuminuria in people with T2D. We measured vascular stiffness in 133 participants (carotid-femoral pulse wave velocity (PWV)) at baseline and end of study (mean follow-up 2.8 years). Results: Participants (age, 62 ± 7 years; 28% female) were characterised by well controlled traditional risk factors: blood pressure 135 ± 13 / 77 ± 9 mmHg; HbA1c, 63 ± 12 mmol/mol; total cholesterol, 4.3 ± 1.1 mmol/L; urinary albumin:creatinine ratio, 6.5 ± 4.6 mg/g; estimated glomerular filtration rate; 87 ± 13 mL/min. Median BMI was 30.7 kg/m2 (range, 20.4 to 48.9 kg/m2). During follow-up PWV remained on average stable (baseline, 9.6 ± 1.6; follow-up, 9.6 ± 1.7 m/s; P = 0.884) although 71 participants experienced an increase and 62 a decrease in PWV. Of all the above baseline parameters only BMI was associated with change in PWV (r = 0.277; P = 0.001), and BMI (median, 29.4 vs 30.5 kg/m2; P = 0.047) was the only significantly different factor (P = 0.010) between the two extreme change in PWV quartiles (−1.5 ± 0.1 vs +1.9 ± 0.3 m/s). We found that obese participants (BMI > 30 kg/m2; n = 75) had greater increase in PWV (+0.26 ± 1.18 vs −0.25 ± 1.37; P = 0.025) than normal and overweight participants (BMI < 30 kg/m2; n = 58). Conclusions: In this cohort with well controlled risk factors there was overall no significant change in PWV during follow-up. Obese people, however, experienced greater PWV progression than normal and overweight individuals. Whilst blood pressure and diabetes control are very good in this cohort, obesity remains a difficult-to-treat risk factor for vascular stiffening. In people at risk of diabetic kidney disease such as participants of the PRIORITY study, weight reduction strategies could help to further improve cardiovascular health.