Abstract-Obesity has reached epidemic levels and carries a risk for cardiovascular disease. Obesity's effects on the vascular systems of young adults and African Americans have not been well characterized. The aim of this study was to assess the association between measures of obesity and aortic stiffness in 186 young adults (20 to 40 years, 50% African American) and 177 older adults (41 to 70 years, 33% African American). Aortic stiffness was measured by aortic pulse-wave velocity. The median pulse-wave velocity value was 468 cm/s for young adults and 627 cm/s for older adults (PϽ0.001). Higher body weight, body mass index, waist and hip circumferences, and waist-hip ratio were strongly correlated with higher pulse-wave velocity, independent of age, systolic blood pressure, race, and sex overall and among both age groups (PϽ0.01 for all). Even among the 20-to 30-year-olds, obese individuals (body mass indexϾ30) had a mean pulse-wave velocity value 47 cm/s higher than did nonobese individuals (PϽ0.001). Obesity measures were among the strongest independent predictors of pulse-wave velocity overall and for both age groups. Results were consistent by race. In conclusion, excess body weight is associated with higher aortic stiffness in whites and African Americans as young as 20 to 30 years. The strength of the association, the early age at which it appears, and the prevalence of obesity among the young warn of substantially increased cardiovascular disease incidence as this cohort ages.
Abstract-Risk factors for arterial stiffness progression have not been well characterized. We examined the relationship between arterial stiffness progression and body weight and weight gain in a group of healthy young adults. Aortic pulse-wave velocity was assessed at 2 time points approximately 2 years apart in 152 white and black adults aged 20 to 40 years, and was standardized by the time between visits to obtain annualized pulse-wave velocity changes. Blacks had 15.5 cm/s per year larger annual pulse-wave velocity increases compared with whites (Pϭ0.02), even after multivariable adjustment for weight and blood pressure changes. Larger annual pulse-wave velocity increases were also associated with larger baseline body weight (Pϭ0.02), waist girth (Pϭ0.003), and body mass index (PϽ0.001), and greater annual weight gain (Pϭ0.02), after adjustment for baseline pulse-wave velocity. After multivariable adjustment that included blood pressure changes, larger baseline waist girth (Pϭ0.009), baseline body mass index (Pϭ0.001), body mass index increase (Pϭ0.037), and weight gain (Pϭ0.017) remained significantly associated with larger annual pulse-wave velocity progression. Weight change showed a direct relationship with pulse-wave velocity change; mean annual pulse-wave velocity changes were Ϫ29.9 cm/s per year (regression) for those with Ն4.5 kg annual weight loss and 18.2 cm/s per year (progression) for those with Ն4.5 kg annual weight gain. These data show strong associations between weight gain and arterial stiffness progression, as well as between weight loss and arterial stiffness regression. These data greatly underscore the vascular benefit of weight loss. Successful weight loss programs in young adults, particularly blacks, are needed.
Objective. Women with systemic lupus erythematosus (SLE) are at high risk of cardiovascular disease (CVD). The goals of this study were to determine the extent of atherosclerotic progression among women with SLE compared with a group of healthy controls and to determine whether factors attributed to SLE or its treatment were associated with atherosclerotic progression independent of traditional CVD risk factors.Methods. A longitudinal study of women with SLE from the Pittsburgh Lupus Registry was conducted. Women 18 years of age and older (n ؍ 217) underwent carotid ultrasound at baseline and at followup, an average of 4.19 years later. Clinical, serologic, and SLE-related factors, and disease treatment were evaluated. Outcomes were changes in carotid intima-media thickness (IMT) and plaque. Progression of CVD in a sample of women without lupus was used for comparison.Results. The patients' mean ؎ SD age at baseline was 45.1 ؎ 10.3 years, and the mean ؎ SD IMT progression rate was 0.011 ؎ 0.03 mm per year. After controlling for traditional CVD risk factors, higher serum creatinine levels were associated with IMT progression (P ؍ 0.0006). Plaque prevalence was 31% at baseline and 40% at followup; plaque progression occurred in 27% of the patients. Higher serum C3 levels and immunosuppressant use at baseline were related to plaque progression (P ؍ 0.04 and P ؍ 0.02, respectively) independent of traditional CVD risk factors. The plaque progression rate was higher than, and the IMT progression rate was similar to, those in the control group. Conclusion. SLE patients have accelerated plaque progression compared with controls. SLE-related risk factors are associated with the progression of IMT and plaque after controlling for traditional CVD risk factors. Carotid B-mode ultrasound may serve as a surrogate end point in SLE intervention trials and clinically to track SLE management.Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease that primarily affects women. It manifests with frequent exacerbations of inflammatory flares that ultimately may cause organ failure. Treatment consists of antiinflammatory and immunosuppressive agents. Patients with SLE are at higher risk of cardiovascular disease (CVD) compared with women of similar ages (1-5). Individuals with SLE who are younger than 45 years of age were found to have a 50-fold higher risk of myocardial infarction (MI) compared with women of similar age in the Framingham Study (6). Cross-sectional and retrospective studies have shown that traditional risk factors, including hypertension, obesity, diabetes mellitus, smoking, hyperlipidemia, hyperhomocysteinemia, and sedentary lifestyle, play a role in this accelerated atherosclerosis (3,7,8). However, the diagnosis of SLE remains a strong risk factor for CVD, even after controlling for traditional risk factors. The most important SLE factors contributing to premature CVD remain unknown.Noninvasive imaging techniques have been used to explore why SLE predisposes women to excess CVD risk. Using...
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