Adiposity, Obesity, and Arterial Aging

A ortic stiffness is a key characteristic of arterial aging and a strong predictor of cardiovascular events. An exaggerated blood pressure response during daily activities, producing increased load on the heart and blood vessels, is among the pathogenic consequences of an inelastic aorta. 5 In view of the important pathophysiological role of aortic stiffness, the modi-fiable determinants of stiffening need to be better understood by studying longitudinal changes. As a consequence of the obesity epidemic, general and central adiposity are highly prevalent. Both are associated with aortic stiffness 6–9 and increased risk of cardiovascular disease. Sparse longitudinal evidence to date leaves uncertainty about the role of adiposity in later midlife in progression of aortic stiffness. In this context, we assessed the effect of adipos-ity on aortic stiffening in a large longitudinal study with 2 measurements of carotid-femoral pulse wave velocity (PWV) 4 years apart, using applanation tonometry. We compared prospective effects of differing measures: general adiposity by body mass index (BMI), central adiposity by waist circumference and waist:hip ratio, and fat mass percent by body impedance. We considered the effect of concurrent change in adiposity. After stratifying the cohort into metabolically healthy and unhealthy participants, defined according to National Cholesterol Education Program Adult Treatment Panel-III criteria, excluding waist circumference, we examined the effects of adiposity on aortic stiffening. 16 We examined the biological pathways linking adiposity with aortic stiffening in a series of models controlling for chronic disease, use of medication, heart rate, metabolic risk factors, and markers of inflammation. Abstract—We sought to determine whether adiposity in later midlife is an independent predictor of accelerated stiffening of the aorta. Whitehall II study participants (3789 men; 1383 women) underwent carotid-femoral applanation tonometry at the mean age of 66 and again 4 years later. General adiposity by body mass index, central adiposity by waist circumference and waist:hip ratio, and fat mass percent by body impedance were assessed 5 years before and at baseline. In linear mixed models adjusted for age, sex, ethnicity, and mean arterial pressure, all adiposity measures were associated with aortic stiffening measured as increase in pulse wave velocity (PWV) between baseline and follow-up. The associations were similar in the metabolically healthy and unhealthy, according to Adult Treatment Panel-III criteria excluding waist circumference. C-reactive protein and interleukin-6 levels accounted for part of the longitudinal association between adiposity and PWV change. Adjusting for chronic disease, antihypertensive medication and risk factors, standardized …