Relationship between arterial stiffness and subsequent cardiac structure and function in young adults with youth-onset type 2 diabetes: Results from the TODAY study

Authors: SHAH, AMY - University Of Cincinnati; GIDDING, SAMUEL - Geisinger Medical Center; EL GHORMLI, LAURE - George Washington University; TRYGGESTAD, JEANIE - University Of Oklahoma Health Sciences Center; NADEAU, KRISTEN - University Of Colorado; BACHA, FIDA - Children'S Nutrition Research Center (CNRC); LEVITT KATZ, LORRAINE - Children'S Hospital - Philadelphia, Pennsylvania; WILLI, STEVEN - Children'S Hospital - Philadelphia, Pennsylvania; LIMA, JOAO - Johns Hopkins University; URBINA, ELAINE - University Of Cincinnati

Submitted to: Journal of the American Society of Echocardiography
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/8/2022
Publication Date: 2/8/2022
Citation: Shah, A.S., Gidding, S.S., El Ghormli, L., Tryggestad, J.B., Nadeau, K.J., Bacha, F., Levitt Katz, L.E., Willi, S.M., Lima, J., Urbina, E.M., TODAY Study Group. 2022. Relationship between arterial stiffness and subsequent cardiac structure and function in young adults with youth-onset type 2 diabetes: Results from the TODAY study. Journal of the American Society of Echocardiography. 35(6):620-628. https://doi.org/10.1016/J.ECHO.2022.02.001.
DOI: https://doi.org/10.1016/J.ECHO.2022.02.001

Interpretive Summary: It is unclear if arterial stiffness in youth leads to changes in in heart function. To address this question, investigators examined arterial stiffness in 388 participants with type 2 diabetes (mean age 21 years; diabetes duration, 7.7 years), and the relationship to measures of heart function on echocardiogram obtained 2 years later. Arterial stiffness was significantly associated with left ventricular mass index and diastolic function. There was a greater adverse effect of arterial stiffness on heart function among participants with higher levels of blood pressure over time. Arterial stiffness was unrelated to left ventricular systolic function. These findings suggest an association of higher arterial stiffness with future left ventricular diastolic dysfunction; thus, the path to future heart failure may begin early in life in youth-onset type 2 diabetes.

Technical Abstract: Higher arterial stiffness may contribute to future alterations in left ventricular systolic and diastolic function. We tested this hypothesis in individuals with youth-onset type 2 diabetes from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Arterial stiffness (pulse wave velocity [carotid-femoral, femoral-foot, and carotid-radial], augmentation index, brachial distensibility) was measured in 388 participants with type 2 diabetes (mean age, 21 years; diabetes duration, 7.7 +/- 1.5 years). To reflect overall (composite) vascular stiffness, the five arterial stiffness measures were aggregated. An echocardiogram was performed in the same cohort 2 years later. Linear regression models assessed whether composite arterial stiffness was associated with left ventricular mass index or systolic and diastolic function, independent of age, sex, race/ethnicity, current cigarette smoking, and long-term exposure (time-weighted mean values over 9.1 years) of hemoglobin A1C, blood pressure, and body mass index. Interactions among arterial stiffness and time-weighted mean hemoglobin A1C, blood pressure, and body mass were also examined. After adjustment, arterial stiffness remained significantly associated with left ventricular mass index and diastolic function measured by mitral valve E/Em, despite attenuation by time-weighted mean body mass index. A significant interaction revealed a greater adverse effect of composite arterial stiffness on mitral valve E/Em among participants with higher levels of blood pressure over time. Arterial stiffness was unrelated to left ventricular systolic function. The association of higher arterial stiffness with future left ventricular diastolic dysfunction suggests the path to future heart failure may begin early in life in this setting of youth-onset type 2 diabetes.