Impact of weight loss on ankle‐brachial index and interartery blood pressures

Abstract

Objective To assess whether weight loss improves markers of peripheral artery disease and vascular stenosis. Design and Methods The Action for Health in Diabetes randomized clinical trial compared intensive lifestyle intervention (ILI) for weight loss to a control condition of diabetes support and education (DSE) in overweight or obese adults with type 2 diabetes. Annual ankle and brachial blood pressures over four years were used compute ankle-brachial indices (ABIs) and to assess inter-artery blood pressure differences in 5018 participants. Results ILI, compared to DSE, produced 7.8% (Year 1) to 3.6% (Year 4) greater weight losses. These did not affect prevalence of low (<0.90) ABI (3.60% in DSE versus 3.14% in ILI; p=0.20) or elevated (>1.40) ABI (7.52% in DSE versus 7.59% in ILI: p=0.90), but produced smaller mean (SE) maximum inter-artery systolic blood pressure differences among ankle sites [19.7 (0.2) mmHg for ILI versus 20.6 (0.2) mmHg for DSE (p<0.001)] and between arms [5.8 (0.1) mmHg for ILI versus 6.1 (0.1) mmHg for DSE (p=0.01)]. Conclusions Four years of intensive behavioral weight loss intervention did not significantly alter prevalence of abnormal ABI, however it did reduce differences in systolic blood pressures among arterial sites.

Ankle‐brachial index and inter‐artery blood pressure differences as predictors of cognitive function in overweight and obese older adults with diabetes: results from the Action for Health in Diabetes movement and memory study

“…As a measure of differences in systolic blood pressure measures among arteries, we calculated the maximum inter-artery differences in systolic blood pressure among the four ankle arterial sites (Espeland et al, 2014a), which we will refer to as MIAD.…”

“…If such an association is evident, it may signal that approaches to slowing or preventing declines in ABI may be promising strategies for preserving cognitive function. Secondly, there is growing evidence that other differences in systolic pressures among arterial sites, beyond what is captured by ABI, may also be markers of atherosclerosis (Kimura et al, 2004; Clark et al, 2007; Verberk et al, 2011; Espeland et al, 2014a). ABI evaluations include systolic blood pressure measurements taken from four ankle arterial sites (right and left dorsal pedis and posterior tibial arteries): we are the first to explore whether differences among these measures, and changes in such differences over four years, also serve as independent risk factors for cognitive deficits.…”

The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation

“…Weight reduction improves endothelial function [280] and lowers CRP [281], oxLDL [282], cIMT [283], wave reflections and arterial stiffness [284], especially when combined with exercise [285e287], but does not influence ABI values [288]. Endurance exercise leads to improved central haemodynamics [289] and endothelial function [290]; the effect of high-intensity resistance training on arterial stiffness is detrimental [290].…”

Gender differences in the relationship between adiposity and systolic inter-arm blood pressure difference in Korea adults

“…Previous study suggested that high sIAD might represent hemodynamic differences caused by ongoing endothelial dysfunction and arterial stiffness [12]. Obesity and abdominal obesity are associated with the risk of cardiovascular disease directly or indirectly related to hypertension, hyperglycemia, and lipid metabolism disorders [28,29], and are consistent risk factors of metabolic syndrome that is an independent predictor of arterial stiffness and endothelial dysfunction [30][31][32][33].…”