Adolescent arterial stiffness – a novel risk factor for hypertension and insulin resistance in young adulthood and for type 2 diabetes mellitus in mid-adulthood.
Emerging evidence suggests that arterial stiffness may be a novel risk factor to be targeted in the prevention and treatment of vascular and metabolic diseases from a young age, a review of studies published in the Journal of Hypertension concludes.
The prevalence of hypertension and obesity has been on the increase globally, despite the targeted effort at promoting weight loss, increasing physical activity, and decreasing sedentary time in the general population. This global challenge informed a recent scientific statement from the American Heart Association on further research into obesity and hypertension in order to mitigate this health burden.
Among middle-aged and older adults, arterial stiffness has been established as a strong predictor of cardiovascular events and all-cause mortality. Hence, a few clinical trials among adults are currently ongoing that examines the likelihood of reversing arterial stiffness. However, among children, adolescents, and young adults, arterial stiffness has been consigned to an intermediate marker of cardiovascular disease and death that occurs in middle age, no thanks to limited longitudinal data and repeated measures of arterial stiffness in a fairly healthy growing young population.
Also, the clinical utility of arterial stiffness as a risk factor for early vascular and metabolic diseases is largely unknown in paediatrics. In this review, recent prospective evidence in a large adolescent population and a middle-aged population that emphasised the value of arterial stiffness as a novel risk factor for hypertension, overweight/obesity, insulin resistance, dyslipidemia, and type 2 diabetes mellitus were summarised. It is often asked what are the risk factors for higher arterial stiffness in adolescents. It is known that maternal smoking habits, early life smoking patterns of adolescents, high salt intake, genetic inheritance, obesity, and elevated blood originating in childhood may contribute to higher arterial stiffening in adolescence.
“Arterial stiffening in adolescence seems to be a subtle, stealthy, but potent risk factor for high blood pressure and metabolic alteration initiating a cascade of biological events finally leading to disease formation such as type 2 diabetes mellitus and premature organ damage. It is therefore expedient for clinicians, paediatricians, public health experts, and policymakers to focus on ways to treat, reduce, and possibly reverse arterial stiffness, particularly from adolescence. An arterial stiffness intervention in adolescence may decrease the incidence of hypertension and metabolic diseases in later life, but further studies are needed,” says Andrew Agbaje, a physician and clinical epidemiologist at the University of Eastern Finland.
The paper published in the Journal of Applied Psychology offers possible new link between inflammation and heart disease.
Low-grade inflammation may cause arterial stiffness and preclinical atherosclerosis in otherwise healthy adolescents
Early vascular damage and atherosclerosis in adolescents may be caused by low-grade inflammation, a paper published in the Journal of Applied Physiology concludes. The study was conducted in collaboration between the University of British Columbia in Canada, the University of Bristol in the UK, the University of Exeter in the UK, the University of Illinois in the US, and the University of Eastern Finland.
In adults, it is known that low-grade inflammation is a major cause of circulatory, musculoskeletal, gastrointestinal, and nervous system diseases and it can also get worse due to ageing and poor lifestyle habits. However, in healthy growing children and adolescents, it remains unclear whether low-grade inflammation contributes to premature vascular damage.
“Contrary to some earlier findings, we now know that premature inflammation-induced vascular damage in adolescents, such as higher arterial stiffness, may cause elevated blood pressure, hypertension, insulin resistance, obesity, and elevated heart rate,” says Andrew Agbaje, a physician and clinical epidemiologist at the University of Eastern Finland.
The current study was conducted among 3862 adolescents who were 17 years old and followed up for 7 years until 24 years of age. The results revealed that about 1 in 3 males and 1 in 2 females were at risk of higher and worsening inflammation by age 24 years. The researchers found that increased inflammation in males may cause higher carotid wall thickness, which is a sign of preclinical atherosclerosis. On the other hand, increased inflammation in females may cause higher arterial stiffness. According to the researchers, these sex-specific negative effects of inflammation on different aspects of the blood vessels is a novel finding, and it may help understand the pathogenesis of cardiovascular disease in early life as well as the optimal approach for treatment. To their surprise, the researchers observed that being overweight or obese did not influence the negative effect of inflammation on premature vascular damage.
“The question that comes to mind is what could cause inflammation in healthy children and adolescents?
Unfortunately, the type of diet a child is exposed to may significantly increase inflammation. For example, fruits, vegetables, and fibre-rich foods have significant anti-inflammatory properties and should be encouraged in the family. However, food rich in saturated and trans fats, salty and deep-fried food, red and processed meat, as well as sugary drinks, pastries, and candies may be associated with premature vascular damage since they can significantly raise inflammation,” Agbaje says.
“These novel findings should strengthen our approach to preventing premature vascular damage in adolescents. Public health experts, pediatricians, and health policymakers should encourage families to take up healthier diet choices. One approach is to significantly lower the prices of fruits and vegetables through government subsidy and tax returns,” Agbaje says.
Andrew Agbaje, MD, MPH, Cert. Clinical Research (Harvard), Principal Investigator (urFIT-CHILD). Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland. https://uefconnect.uef.fi/en/person/andrew.agbaje/
Dr Agbaje’s research group (urFIT-child) is supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation sr, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research and the Foundation for Pediatric Research.
Link to the article:
https://doi.org/10.1152/japplphysiol.00701.2022
Webpage: urFIT-CHILD Research group:
https://uefconnect.uef.fi/en/group/understanding-fitness-and-cardiometabolic-health-in-little-darlings-urfit-child/
Agbaje AO. Arterial stiffness precedes hypertension and metabolic risks in youth: a review. J Hypertens. 2022 Jul 11. doi: 10.1097/HJH.0000000000003239
urFIT-CHILD research group
https://uefconnect.uef.fi/en/group/understanding-fitness-and-cardiometabolic-health-in-little-darlings-urfit-child/
