Diabetic and Obese Teen Carotids Appear Elderly
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The carotid arteries of type 2 diabetic or obese teenagers have the look of those their grandfathers might have, suggests a small study.
This study, led by Silva Arslanian, M.D., a pediatric endocrinologist at Children’s Hospital of Pittsburgh, adds to a growing body of evidence that cardiovascular disease takes root in childhood.
“I was flabbergasted,” Dr. Arslanian said in an interview. “Wouldn’t you be surprised that someone who is 14 years old is showing (cardiovascular) signs similar to 60-year-old men?”
Her study of 62 teens, reported in the May issue of Diabetes Care, found that aortic pulse wave velocity (aPWV), a measure of arterial stiffness, was significantly higher among type 2 diabetic adolescents when compared with obese and normal weight teens. And obese children had more abnormal aPWV measurements than normal weight adolescents, who had normal aPWV.
She said these functional changes are typically reversible, but what is unknown is what type of interventions would work to reverse them.
The study looked at 20 adolescents with type 2 diabetes, 20 obese youths, and 22 normal-weight controls. None of the participants had a family history of hyperlipidemia. The average age of the participant was 14. Four of them—three of normal weight and one obese—were smokers. Each participant underwent a physical exam and provided blood samples. Researchers used ultrasound to measure arterial changes.
Carotid artery intima media thickness did not differ among the three groups. However, aPWV (centimeters per second) was highest among those with type 2 diabetes (769.4 ± 81.7) followed by obese adolescents (583.9 ± 26.9) while the normal weight subjects had normal readings (496.9 ± 15.2). These differences were statistically significant (p <0.001)
The researchers also reported that after controlling for systolic blood pressure, aPWV significantly correlated with body mass index (r = 0.50), fasting insulin (r = 0.46), fasting glucose (r = 0.38), homeostasis model assessment of insulin sensitivity (r = -0.52), high sensitivity C-reactive protein (r = 0.47), and triglycerides (r = 0.27).
The study also showed, the researchers concluded, that a “higher aPWV in type 2 diabetes versus equally obese youth of similar age and blood pressure is suggestive of the additional impact of hyperglycemia on vascular stiffness.”
They concluded, “The elevated aPWV in type 2 diabetic youth in our study is comparable with values obtained from 41- to 59-year-old obese adults. These findings may reflect early functional changes in the vasculature… With increasing age and duration of diabetes, these functional changes may progress to structural changes if left without intervention.”
Whether that intervention should be lifestyle, such as diet or exercise, Dr. Arslanian said, or pharmacological is unclear at this point.
When asked to compare her findings to those from the initial landmark Bogalusa Heart Study, Dr. Arslanian said her study was unique because it measured arterial stiffness. The Bogalusa Heart Study, launched in 1972, was the first to suggest anatomic changes that occurred between ages five and eight to set the stage for cardiovascular disease in adulthood.
Dr. Arslanian said the scientific community was more skeptical then about the link between heart disease and childhood, but given the nation’s current childhood obesity epidemic, findings such as hers are receiving more serious attention. According to the CDC, 15% of all children in the United States are overweight or obese, a figure that has tripled since the 1980s.
Dr. Arslanian said type 2 diabetes diagnoses are certainly paralleling the recent spike in childhood obesity.
Primary source: Diabetes Care
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