SEX DIFFERENCES IN ARTERIAL FUNCTION IN OBESITY: THE FAT-ASSOCIATED CARDIOVASCULAR DYSFUNCTION STUDY

Abstract

Objective: Obesity has been associated with increased arterial stiffness, but sex differences in this association have been less explored. We compared different measures of arterial stiffness between women and men with obesity and free of clinical cardiovascular disease participating in the FAT associated dysfunction (FATCOR) study. Design and method: We performed a cross-sectional analysis in 351 women and 233 men with mean age 48 ± 9 years and body mass index (BMI) 32 ± 4 kg/m2. Arterial function was assessed by applanation tonometry as aortic augmentation pressure (AP), augmentation index (AIx), and pulse wave velocity (PWV). Covariables of arterial function were identified in linear regression in the total cohort and in sex-specific analyses. Multivariable models were adjusted for age, body height, BMI, 24-hour systolic blood pressure (BP), heart rate (HR), diabetes, serum low-density lipoprotein, estimated glomerular filtration rate (eGFR), and smoking habit. Results: Women had higher AP and AIx, and lower PWV compared to men (all p < 0.005). Women also had higher BMI and HR, while men had higher BP (all p < 0.05). In the total study cohort, female sex remained independently associated with higher AP (=0.35) and AIx (=0.45) after adjustment for significant confounders including age, BP, HR, and eGFR (all p < 0.02). Male sex was associated with higher PWV (=0.15) independent of age, BP, HR, and smoking habit (all p < 0.02). In sex-specific analyses, higher AP was associated with higher age and BP, and lower HR in women (all p < 0.001), and with higher age, BP, and eGFR in men (all p < 0.01). Similarly, higher AIx was related to higher age and BP, and lower BMI and HR in women (all p < 0.05), and with higher age and eGFR in men (all p < 0.02). Finally, in women, higher PWV correlated with higher age, BP, and HR (all p < 0.05). In men, higher PWV was associated with higher age, HR, and with smoking habit (all p < 0.005). Conclusions: In obese subjects free of clinical cardiovascular disease, measures of arterial stiffness differed between women and men. AP and AIx were higher in women, while PWV was higher in men, independent of important confounders like age and BP.