Hypertension (HT) is associated with increased LVM and carotid intima-media thickness (cIMT) which predict cardiovascular (CV) events in adults. Whether target organ damage (TOD) is found in prehypertensive youth (PreHT) is not known. We measured BMI, BP, fasting glucose, insulin, lipids and CRP, LVM/ht2.7 (LVMI), diastolic function, cIMT, carotid stiffness, augmentation index (AIx), brachial artery distensibility (BrachD), pulse wave velocity (PWV), in 723 subjects 10–23 yrs (29% type 2 diabetes mellitus, T2DM). Subjects were stratified by BP level (normotensive: NT=531, PreHT=65, HT=127). Adiposity and CV risk factors worsened across BP group. There was a graded increase in cIMT, arterial stiffness, and LVMI and decrease in diastolic function from NT to PreHT to HT. In multivariable models adjusted for CV risk factors, status as PreHT or HT remained an independent determinant of TOD for LVM, diastolic function, internal cIMT, carotid and arterial stiffness. PreHT is associated with CV TOD in adolescents and young adults.

Background-Adults with obesity or type 2 diabetes mellitus (T2DM) are at higher risk for stroke and myocardial infarction. Increased carotid intima-media thickness (cIMT) and stiffness are associated with these adverse outcomes.We compared carotid arteries in youth who were lean, were obese, or had T2DM. Methods and Results-Carotid ultrasound for cIMT measurement was performed, the Young elastic modulus and beta stiffness index were calculated, and anthropometric and laboratory values and blood pressure were measured in 182 lean, 136 obese, and 128 T2DM youth (aged 10 to 24 years). Mean differences were evaluated by ANOVA. Independent determinants of cIMT, Young elastic modulus, and beta stiffness index were determined with general linear models. Cardiovascular risk factors worsened from lean to obese to T2DM groups. T2DM subjects had greater cIMT than that in lean and obese subjects for the common carotid artery and bulb. For the internal carotid artery, cIMT measurements in both obese and T2DM groups were thicker than in the lean group. The carotid arteries were stiffer in obese and T2DM groups than in the lean group. Determinants of cIMT were group, groupϫage interaction, sex, and systolic blood pressure for the common carotid artery (r 2 ϭ0.17); age, race, and systolic blood pressure for the bulb (r 2 ϭ0.16); and age, race, sex, systolic blood pressure, and total cholesterol for the internal carotid artery (r 2 ϭ0.21). Age, systolic blood pressure, and diastolic blood pressure were determinants of all measures of carotid stiffness, with sex adding to the Young elastic modulus (r 2 ϭ0.23), and body mass index Z score, group, and groupϫage interaction contributing to the beta stiffness index (r 2 ϭ0.31; all PϽ0.0001). Conclusions-Youth with obesity and T2DM have abnormalities in carotid thickness and stiffness that are only partially explained by traditional cardiovascular risk factors. These vascular changes should alert healthcare practitioners to address cardiovascular risk factors early to prevent an increase in the incidence of stroke and myocardial infarction. (Circulation.

TG/HDL-C, an estimate of small, dense low-density lipoprotein cholesterol, is an independent determinant of arterial stiffness in adolescents and young adults, especially in obese youth. These data suggest that use of TG/HDL-C may be helpful in identifying young adults requiring aggressive intervention to prevent atherosclerotic CV diseases.