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Effect of Weight Loss on Arterial Stiffness in Type 2 Diabetes

Posted: Thursday, October 12, 2006

Moderate weight loss improves arterial stiffness in type 2 diabetes.

There is increased stiffness of the large central arteries in type 2 diabetic patients, and obesity is a risk factor. However, the effect of intentional weight loss on arterial stiffness is uncertain, and the purpose of the current study was to assess this effect.

Arterial stiffness was assessed by measuring aortic pulse wave velocity (aPWV) at baseline and at completion of a 1-year weight loss intervention. Metabolic control of type 2 diabetes was also appraised.

Mean weight loss at 1 year in 38 volunteers with type 2 diabetes was 7.8%. There were improvements in HbA1c, LDL cholesterol, homeostasis model assessment of insulin resistance, and inflammatory markers (plasminogen activator inhibitor-1, tumor necrosis factor- , interleukin-6, and C-reactive protein). There was also a significant improvement in aPWV at completion of weight loss intervention, from 740 to 690 cm/s (P < 0.05).

Hypertension is strongly associated with arterial stiffness, and prior intervention studies have shown that treatment of hypertension improves arterial stiffness. However, in the current study, we can reasonably conclude that this was not the mechanism for weight loss–induced improvement in aPWV since blood pressure was well controlled at baseline and did not change during the 1-year weight loss intervention. There was a significant improvement in fasting hyperglycemia and A1C at 1 year, consistent with the effect now expected from 5 to 10% weight loss. There was a more modest, but nevertheless significant, reduction in LDL cholesterol and HOMA-IR. As well, there were significant decreases in PAI-1, TNF- , IL-6, and C-reactive protein. Improvement in aPWV following weight loss may be related to improved metabolic control and changes in obesity-related inflammation. However, these metabolic factors did not significantly correlate with the improvement in aPWV. Greater improvement also occurred in the tertile of largest weight loss. These findings suggest that in overweight and obese patients with type 2 diabetes and elevated values for aPWV, moderate weight loss is an effective intervention to improve arterial stiffness.

Source: Diabetes In Control: Diabetes Care 29:2218-2222, 2006