Carotid Stiffness in Young Adults: A Life-Course Analysis of its Early Determinants

Abstract

Abstract-Cardiovascular risk factors affecting arterial stiffness in adulthood may develop at different critical periods earlier in life. We examined whether the trajectories, from adolescence to young adulthood, of blood pressure, body fatness and fat distribution, blood lipids, cardiorespiratory fitness, and heart rate determined levels of arterial stiffness in young adults. We investigated 373 apparently healthy adults in whom cardiovascular risk factors were repeatedly examined between the ages of 13 and 36 years and carotid stiffness estimates were obtained at the age of 36 years. Differences in the mean levels and the trajectories of risk factors throughout the 24-year longitudinal period between subjects with different levels of carotid stiffness at age 36 years were analyzed with generalized estimating equations. Compared with individuals with less stiff carotid arteries, those with stiffer carotid arteries at the age of 36 years were characterized from ages 13 to 36 years by greater levels of and steeper increases in blood pressure and central fatness, independently of each other and other risk factors. These increases were already present in adolescence, preceded the development of poorer levels of blood lipids, cardiorespiratory fitness, and heart rate, which were evident during adulthood only, and explained to a great extent the deleterious association between these risk factors and carotid stiffness at the age of 36 years. Multiple and intertwined mechanisms involved in the pathogenesis of arterial stiffness have their origins in early life. Blood pressure and central fatness have a pivotal role herein and should be specifically targeted to prevent arterial stiffening and its cardiovascular sequelae. A rterial stiffness is an important cause of cardiovascular disease because of its contribution to systolic hypertension, left ventricular hypertrophy, and impaired coronary perfusion. 1-3 Arterial stiffness is primarily determined by aging and mean arterial pressure (MAP), 2,4 but other risk factors (RF) may also contribute, notably body fatness and/or a central pattern of fat distribution, 5-8 impaired glucose metabolism and insulin resistance, 2 poor cardiorespiratory fitness, 9,10 and dyslipidemia. 11,12 Recently, a systematic review suggested that the contribution to arterial stiffness of RF other than blood pressure (BP) was only modest, although this evidence was derived from cross-sectional studies only. 13 Therefore, a life-course rather than a single time-point approach to the study of (early) determinants of arterial stiffness is needed.The negligible, if any, role of RF other than BP on arterial stiffness was also emphasized in a prospective analysis conducted among men throughout middle age and older age. 14 However, some evidence suggests that arterial stiffness in adulthood has its roots early in life. Indeed, studies among the young have shown that greater levels of BP 15,16 and body fatness and/or a central pattern of fat distribution 5,15,17 measured in childhood/adolescence were as...

Clustering of Metabolic Syndrome Traits Is Associated With Maladaptive Carotid Remodeling and Stiffening

“…13 In the year 2000, when subjects' mean age was 36.6 years (Ϯ0.6 years), measurements of large artery properties by means of noninvasive ultrasound were included for the first time in this cohort and obtained in 373 subjects (baseline data of the present study). [14][15][16][17] In 2006, follow-ups of arterial measurements were obtained in 297 of these individuals, 293 of whom had complete data on carotid artery properties and traits of the MetS at both time points (the sample of the present study). However, baseline characteristics from the 80 individuals without complete follow-up data did not differ from those included (data not shown).…”

“…Throughout the longitudinal period, anthropometric (body height, weight, and waist circumferences), biological (blood lipids and BP), and lifestyle (smoking status, alcohol consumption, and physical activity levels) variables were assessed according to standard procedures, as detailed elsewhere. [14][15][16][17] The medical ethical committee of the VU University Medical Center in Amsterdam approved the study, and all of the participants gave written informed consent.…”

Cardiometabolic Determinants of Carotid and Aortic Distensibility From Childhood to Early Adulthood

“…25,26 Previous studies have also shown that higher BP levels in childhood associate with stiffer arteries later in adulthood. 4,23,27 These observations suggest that already at early age increased BP associates with decreased The models include risk markers showing significant association with carotid or aortic distensibility in age-and sexadjusted models (Figure 1). Systolic blood pressure represents blood pressure and HOMA-IR glucose homeostasis.…”

“…21,22 Interestingly, childhood obesity is also shown to relate with carotid artery stiffening later in adulthood. 4,23 These findings suggest that maintaining normal body weight in childhood may, in part, prevent from acceleration of arterial stiffening. Similar to our results, prior studies in children and adults have reported the inverse association of BP with arterial distensibility.…”

Epidemiology of elevated blood pressure in youth and its utility for predicting adulthood outcomes: A review

“…Additional research has indicated that pathological changes, such as markers of atherosclerosis and changes in left ventricular morphology, measured concurrently or in Kelly RK et al . Youth blood pressure and adulthood outcomes adulthood, are associated with elevated youth blood pressure [10][11][12][13][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] . These changes are largely asymptomatic and are detectable prior to signs of end-organ damage such as nephropathy and retinopathy.…”