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Urbina et al “Insulin resistance and arterial stiffness in healthy adolescents” Diabetalogia 2012;55:625-631

The question: Does increasing arterial stiffness reflect worsening insulin resistance?

What was done: Carotid-femoral pulse wave velocity (c-fPWV) on 343 adolescents and young adults who were participating in a longitudinal school-based study of the effect of obesity on developing diabetes.

The main points:

- Obese subjects (BMI 36 kg/m2) and subjects with obesity with insulin resistance (BMI 38.4 kg/m2) had higher c-fPWV than lean (BMI 23.2 kg/m2). The c-FPWV was 0.7 to 0.8 m/sec higher in the obese groups as compared to lean controls.

- After adjustments for race and mean arterial pressure, PWV was still significantly higher in obese groups. Insulin resistance was not an independent determinant of PWV. However, obesity was important as it remained a significant determinant in multivariable linear regression and adjustment for BMI abolished the c-fPWV among groups.

- Metabolic syndrome-type risk factor clustering is associated with vascular compromise in otherwise healthy, non diabetic adolescents and young adults.

Limitations: Cross sectional study, no lean insulin resistant group.

Comment: Reference values for arterial stiffness in adults have been published (2010, PMID: 20530030) helping to move the field forward. Similar data in children are lacking. Longitudinal evaluations defining ‘normal’ vascular aging in youth are also needed. These data would have the potential to elucidate determinants of ‘accelerated’ vascular aging in pediatric patients assisting practitioners in the identification of high risk youth needing aggressive early intervention.

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