Relation of Overall & Abdominal Adiposity to Vascular Health
Relation of Overall & Abdominal Adiposity to Vascular Health
Objective The present study investigated the impact of overall obesity defined by BMI and abdominal obesity defined by WC on vascular atherosclerotic changes in obese and normal weight diabetic subjects.
Design and methods 285 subjects were divided according to presence diabetes mellitus (DM) and obesity: Group 1 included 144 nonobese subjects without DM; Group 2 consisted of 141 type 2 diabetic patients. Then diabetic patients were divided into two groups according to presence of overall obesity, defined by BMI and furthermore, abdominal obesity, defined by waist circumference (WC). Pulse wave velocity (PWV) and augmentation index (AI) were performed using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia).
ResultsBetween Group Comparisons by BMI: Diabetic subjects with and without overall obesity did not differ from one another in terms of AI and PWV.
Between Group Comparisons by WC: AI as well as PWV increased consistently from Group 1 to Group 3, AI and PWV were significantly higher in abdominally obese diabetic subjects than in the diabetics without abdominal obesity (p = 0.008 and p = 0.013, respectively). Significant by-group differences in PWV and AI persisted after adjustment for age, sex, blood pressure, fasting glucose and BMI.
Conclusions Abdominal obesity defined by WC was associated with significantly higher AI and PWV in in both diabetic men and women; whereas overall obesity defined by BMI did not predict adverse vascular changes in this study population. Abdominal obesity was associated with an adverse effect on blood vessels, independently of age, sex, blood pressure, fasting glucose and BMI.
In diabetes, arterial stiffening is consistently observed across all age groups and may contribute, in part, to the excess cardiovascular morbidity and mortality observed in these patients. Several pre-existing risk factors including hypertension, dyslipidemia and obesity may further increase the cardiovascular risk associated with hyperglycemia, leading to excess CVD risk at an earlier age. Physiopathology that links increased adiposity as well as diabetes to arterial stiffening is not precisely known. One suggested mechanism is through insulin resistance, which commonly accompanies obesity and type 2 diabetes mellitus. A reciprocal relationship exists between insulin resistance and endothelial dysfunction, considered to be a key initiating step in the atherosclerotic cascade. However, not all type 2 diabetic individuals demonstrate similar insulin resistance as well as cardiovascular risk factor profiles. Obese type 2 diabetics have significantly decreased insulin-stimulated glucose disposal and insulin sensitivity index, confirming that insulin resistance is the major contributor to the pathogenesis of hyperglycemia in obese subjects with type 2 DM , whereas lean type 2 diabetics are characterized primarily by a defect in insulin secretion. Currently, there is no consistent evidence regarding differences in term of cardiovascular morbidity and mortality between obese and nonobese diabetic patients. Even less information is available regarding vascular impact of different obesity anthropometric indexes such as waist circumference (WC) and body mass index (BMI) in obese and normal weight diabetic subjects.
Estimation of arterial stiffness has been reported to be a useful method for assessment of early preclinical atherosclerosis. PWV, which is associated with higher risk of cardiovascular morbidity and mortality and AI, which recently been considered as a valid biomarker, provide valuable information regarding vascular health.
The present study was designed to investigate the impact of overall obesity defined by BMI and abdominal obesity defined by WC on vascular atherosclerotic changes in obese and normal weight diabetic subjects.
Abstract and Introduction
Abstract
Objective The present study investigated the impact of overall obesity defined by BMI and abdominal obesity defined by WC on vascular atherosclerotic changes in obese and normal weight diabetic subjects.
Design and methods 285 subjects were divided according to presence diabetes mellitus (DM) and obesity: Group 1 included 144 nonobese subjects without DM; Group 2 consisted of 141 type 2 diabetic patients. Then diabetic patients were divided into two groups according to presence of overall obesity, defined by BMI and furthermore, abdominal obesity, defined by waist circumference (WC). Pulse wave velocity (PWV) and augmentation index (AI) were performed using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia).
ResultsBetween Group Comparisons by BMI: Diabetic subjects with and without overall obesity did not differ from one another in terms of AI and PWV.
Between Group Comparisons by WC: AI as well as PWV increased consistently from Group 1 to Group 3, AI and PWV were significantly higher in abdominally obese diabetic subjects than in the diabetics without abdominal obesity (p = 0.008 and p = 0.013, respectively). Significant by-group differences in PWV and AI persisted after adjustment for age, sex, blood pressure, fasting glucose and BMI.
Conclusions Abdominal obesity defined by WC was associated with significantly higher AI and PWV in in both diabetic men and women; whereas overall obesity defined by BMI did not predict adverse vascular changes in this study population. Abdominal obesity was associated with an adverse effect on blood vessels, independently of age, sex, blood pressure, fasting glucose and BMI.
Introduction
In diabetes, arterial stiffening is consistently observed across all age groups and may contribute, in part, to the excess cardiovascular morbidity and mortality observed in these patients. Several pre-existing risk factors including hypertension, dyslipidemia and obesity may further increase the cardiovascular risk associated with hyperglycemia, leading to excess CVD risk at an earlier age. Physiopathology that links increased adiposity as well as diabetes to arterial stiffening is not precisely known. One suggested mechanism is through insulin resistance, which commonly accompanies obesity and type 2 diabetes mellitus. A reciprocal relationship exists between insulin resistance and endothelial dysfunction, considered to be a key initiating step in the atherosclerotic cascade. However, not all type 2 diabetic individuals demonstrate similar insulin resistance as well as cardiovascular risk factor profiles. Obese type 2 diabetics have significantly decreased insulin-stimulated glucose disposal and insulin sensitivity index, confirming that insulin resistance is the major contributor to the pathogenesis of hyperglycemia in obese subjects with type 2 DM , whereas lean type 2 diabetics are characterized primarily by a defect in insulin secretion. Currently, there is no consistent evidence regarding differences in term of cardiovascular morbidity and mortality between obese and nonobese diabetic patients. Even less information is available regarding vascular impact of different obesity anthropometric indexes such as waist circumference (WC) and body mass index (BMI) in obese and normal weight diabetic subjects.
Estimation of arterial stiffness has been reported to be a useful method for assessment of early preclinical atherosclerosis. PWV, which is associated with higher risk of cardiovascular morbidity and mortality and AI, which recently been considered as a valid biomarker, provide valuable information regarding vascular health.
The present study was designed to investigate the impact of overall obesity defined by BMI and abdominal obesity defined by WC on vascular atherosclerotic changes in obese and normal weight diabetic subjects.
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