Arterial stiffness is a novel risk factor to be targeted for preventing and treating hypertension and obesity from a young age, according to a new study (“Effects of arterial stiffness and carotid intima-media thickness progression on the risk of overweight/obesity and elevated blood pressure/hypertension: a cross-lagged cohort study”) published in Hypertension. Researchers from the University of Eastern Finland, the University of Exeter, and the University of Bristol conducted the study using data from one of the world’s most extensive ongoing prospective birth cohort studies–the Avon Longitudinal Study of Parents and Children (ALSPAC).
“We examined the temporal longitudinal associations of carotid-femoral pulse wave velocity (cfPWV), a measure of arterial stiffness, and carotid intima-media thickness (cIMT) with the risk of overweight/obesity and elevated blood pressure (BP)/hypertension. We studied 3,862 adolescents aged 17.7 years from the Avon Longitudinal Study of Parents and Children, followed-up for 7 years. cfPWV and cIMT were measured by ultrasound,” write the investigators.
“Total and trunk fat mass and lean mass were assessed by dual-energy X-ray absorptiometry. Body mass index and BP were measured. Data were analyzed using logistic regression, linear mixed-effect, and cross-lagged structural equation models, with covariate adjustments. Among 1719 male and 2143 female participants, higher cfPWV at 17.7 years was associated with the risk of elevated systolic BP/hypertension (odds ratio, 1.20 [1.02–1.41]; P=0.026), elevated diastolic BP/hypertension (1.77 [1.32–2.38]; P<0.0001), body mass index-overweight/obesity (1.19 [1.01–1.41]; P=0.041), and trunk fat mass overweight/obesity (1.24 [1.03–1.49]; P=0.023) at 24.5 years.
“Higher cIMT at 17.7 years had no associations with obesity and elevated BP at follow-up. cfPWV progression was directly associated with 7-year increase in systolic BP (effect estimate 16 mm Hg [9–24]; P<0.0001) and diastolic BP (28 mm Hg [23–34]; P<0.0001). cIMT progression was directly associated with the 7-year increase of all adiposity measures and diastolic BP. In the temporal analysis, baseline cfPWV was directly associated with follow-up systolic and diastolic BP, however, baseline BP was unassociated with follow-up cfPWV. cfPWV but not cIMT was bidirectionally associated with adiposity.
“Obesity and hypertension prevention from adolescence may require developing novel approaches to mitigate arterial stiffness.”
In the newly published study, the researchers examined whether atherosclerotic traits such as arterial stiffness temporally precede the development of hypertension and obesity. This is the first time over 3,800 adolescents, aged 17 years were followed up for seven years. The researchers employed a number of statistical approaches to untangle potential causal associations.
The researchers found that higher arterial stiffness during adolescence increased the risk of systolic hypertension by 20% and diastolic hypertension by two-fold, seven years later. Moreover, participants were categorized into four equal groups according to their level of arterial stiffness.
Adolescents whose arterial stiffness levels were in the highest quartile both at 17 years of age and 24 years of age had a systolic blood pressure increase of 4 mmHg, and their diastolic blood pressure increased by 3 mmHg during the seven-year observation period. Of note, mild elevations in systolic and diastolic blood pressure were also observed in adolescents with mildly increased arterial stiffness but within normal limits.
However, the change in blood pressure in the “mild” group was half that of the change in the “high” group. These results were similar in both males and females, despite controlling for important risk factors such as smoking, physical activity, lipid and glucose, body fat, heart rate, family history of cardiovascular diseases, etc.
Previous studies have focused on the adverse effect of obesity on the heart and blood vessels. However, the present study found that higher arterial stiffness at age 17 years increased the risk of abdominal obesity and whole-body obesity by 20% at age 24 years.
The findings reveal a possible two-way direction between unhealthy arteries and obesity, although the evidence was stronger for obesity leading to unhealthy arteries, and not vice versa.
A recent American Heart Association scientific statement notes that “lifestyle modification, including diet, reduced sedentariness, and increased physical activity, is usually recommended for patients with obesity; however, the long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited.” It has also been established that a 5 mmHg rise in blood pressure over five years increases the risk of death in the adult population by 16%.
“Therefore, our novel findings are significant clinically and for population health, in that future hypertension and obesity prevention and treatment strategies may now consider reducing arterial stiffness, particularly from adolescence,” says Andrew Agbaje, MD, a physician and clinical epidemiologist at the University of Eastern Finland.
