Youth with obesity, obesity-related diabetes demonstrate cardiac abnormalities

Youth who develop obesity and obesity-related type 2 diabetes have higher carotid intima-media artery thickness and stiffness.

Researchers measured carotid intima-media thickness in 182 lean patients, 136 participants with obesity and 128 participants with type 2 diabetes (aged between 10 and 24 years). Participants were evaluated with cardiac ultrasonography, during which carotid intima-media thickness was measured.

The researchers reported that for all carotid segments, participants with type 2 diabetes had greater carotid intima-media thickness vs. lean patients (P=.05). Participants in the type 2 diabetes group also had thicker carotid media-intima thickness vs. participants in the obesity group for the common carotid artery and the bulb, but not the inner carotid artery (P=.05). The researchers also reported that group, group-age interaction, sex and systolic blood pressure were independent determinants of intima-media thickness in the common carotid artery. There was also a an association between age and obesity levels and increased carotid intima-media thickness in the presence of type 2 diabetes (P<.0002). BP, along with age, was also a determinant of carotid artery stiffness.

“These findings are particularly disturbing because the prevalence of obesity-related metabolic syndrome and type 2 diabetes in youth is increasing across the globe and may lead to a parallel increase in adverse cardiovascular outcomes,” the researchers wrote. “Therefore, pediatric health care practitioners should continue to screen for abnormalities in CV risk factors, especially in children with elevated BMI or type 2 diabetes. Comprehensive lifestyle interventions to reduce obesity must be applied now if we are to prevent a projected decline in life expectancy for our youth.” – by Eric Raible

Urbina. Circulation. 2009;doi:10.1161/CIRCULATIONAHA.108.830380.

We have known for many years based on autopsy studies of causalities of war that atherosclerosis starts at a very early age. These observations were at time when obesity was not a problem but when smoking behavior was quite prevalent. With the obesity epidemic, it is not surprising that atherosclerosis would be present at an early age. Urbina and colleagues clearly demonstrate that youth with obesity and diabetes have abnormalities in carotid thickness and stiffness that are only partially explained by traditional CV risk factors. Given that little effort is being made to change availability of fatty foods and increase exercise programs in schools, this problem will not improve in the near future. As a result pediatricians are faced with a disease previously seen almost exclusively by internists. Hence, all physicians need to not only identify risk factors in younger people, but pay particular attention to those with a family history of diabetes and related CV complications and be even more aggressive with treatment in such patients. This pathology has been shown to be reversible if intervention occurs early in the disease course. Therefore, we should all act swiftly.

– George Bakris, MD

University of Chicago-Pritzker School of Medicine