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Arterial stiffness and risk factors for cardiovascular disease in young adults
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-6520-9265
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Atherosclerosis is a complex, chronic vessel wall disease that often leads to severe and acute cardiovascular diseases (CVD), such as myocardial infarction and stroke. CVD are the most common cause of death, both globally and in Sweden. Since most of the risk factors for atherosclerosis are preventable, it is of great importance to highlight the benefits of a healthy lifestyle to young adults who are about to create their own habits.

A general concern about physical inactivity, low cardiorespiratory fitness (CRF), and high body mass are supported by reports of an increased incidence and prevalence of obesity worldwide. In addition to this, the proportion of Swedish adults with low CRF almost doubled the last 20 years and the decline in CRF is more pronounced in the youngest age group.

The scientific work presented in this thesis was carried out to investigate the impact of different lifestyle related factors on vascular status, especially arterial stiffness, in young Swedish adults. In total 840 young adults in the age range 18-25 years were recruited to the cross-sectional Lifestyle, Biomarkers, and Atherosclerosis (LBA) study, to examine vascular status, biomarkers, and lifestyle related factors.

In the LBA study population of young adults in Sweden, 12% were classified as being at risk of future CVD. A high CVD risk was associated with low CRF and less physical activity. In the total study population 24% had unhealthy food habits, and 24% did not spend the recommended 30 minutes per day at moderate or vigorous intensities of physical activity. Low CRF, less physical activity, and overweight and obesity, were associated with stiffer arteries.

The results raises concerns about future CVD risk and highlights the health enhancing possibilities of high CRF and physical activity on vascular status in young Swedish adults.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2019. , p. 98
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 201
Keywords [en]
Cardiovascular disease, atherosclerosis, arterial stiffness, pulse wave analysis, intima media thickness, cardiorespiratory fitness, physical activity, body composition, young adults
National Category
Other Basic Medicine
Identifiers
URN: urn:nbn:se:oru:diva-75985ISBN: 978-91-7529-306-6 (print)OAI: oai:DiVA.org:oru-75985DiVA, id: diva2:1347116
Public defence
2019-11-15, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2019-08-30 Created: 2019-08-30 Last updated: 2019-10-23Bibliographically approved
List of papers
1. Aerobic fitness is associated with low cardiovascular disease risk: the impact of lifestyle on early risk factors for atherosclerosis in young healthy Swedish individuals - the Lifestyle, Biomarker, and Atherosclerosis study
Open this publication in new window or tab >>Aerobic fitness is associated with low cardiovascular disease risk: the impact of lifestyle on early risk factors for atherosclerosis in young healthy Swedish individuals - the Lifestyle, Biomarker, and Atherosclerosis study
2017 (English)In: Vascular Health and Risk Management, ISSN 1176-6344, E-ISSN 1178-2048, Vol. 13, p. 91-99Article in journal (Refereed) Published
Abstract [en]

Background: The progression of cardiovascular disease (CVD) and atherosclerosis is slow and develops over decades. In the cross-sectional Swedish Lifestyle, Biomarker, and Atherosclerosis study, 834 young, self-reported healthy adults aged 18.0-25.9 years have been studied to identify early risk factors for atherosclerosis.

Purpose: The aims of this study were to 1) assess selected cardiometabolic biomarkers, carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis, and lifestyle-related indicators (food habits, handgrip strength, and oxygen uptake, VO(2)max);2) analyze the associations between cIMT and lifestyle factors; and 3) identify subjects at risk of CVD using a risk score and to compare the characteristics of subjects with and without risk of CVD.

Method: Blood samples were taken in a fasting state, and food habits were reported through a questionnaire. cIMT was measured by ultrasound, and VO2 max was measured by ergometer bike test. The risk score was calculated according to Wildman.

Result: cIMT (mean +/- standard deviation) was 0.50 +/- 0.06 mm, and VO2 max values were 37.8 +/- 8.5 and 42.9 +/- 9.9 mL/kg/min, in women and men, respectively. No correlation was found between aerobic fitness expressed as VO2 max (mL/kg/min) and cIMT. Using Wildman's definition, 12% of the subjects were classified as being at risk of CVD, and 15% had homeostasis model assessment of insulin resistance. A total of 35% of women and 25% of men had lower high-density lipoprotein cholesterol than recommended. Food habits did not differ between those at risk and those not at risk. However, aerobic fitness measured as VO2 max (mL/kg/min) differed; 47% of the subjects at risk had low aerobic fitness compared to 23% of the nonrisk subjects (P<0.001).

Conclusion: High aerobic fitness is associated with low CVD risk in Swedish young adults. The high prevalence of young adults observed with unfavorable levels of high-density lipoprotein cholesterol and homeostasis model assessment of insulin resistance raises concerns about future CVD risk.

Place, publisher, year, edition, pages
DOVE Medical Press Ltd., 2017
Keywords
cIMT, cholesterol, insulin resistance, body fat, diet, aerobic fitness
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:oru:diva-56877 (URN)10.2147/VHRM.S125966 (DOI)000396188000002 ()28352184 (PubMedID)2-s2.0-85015747630 (Scopus ID)
Note

Funding Agency:

AFA insurance

Available from: 2017-03-29 Created: 2017-03-29 Last updated: 2019-10-22Bibliographically approved
2. Arterial stiffness is associated to cardiorespiratory fitness and body mass index in young Swedish adults: The Lifestyle, Biomarkers, and Atherosclerosis study
Open this publication in new window or tab >>Arterial stiffness is associated to cardiorespiratory fitness and body mass index in young Swedish adults: The Lifestyle, Biomarkers, and Atherosclerosis study
2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 17, p. 1809-1818Article in journal (Refereed) Published
Abstract [en]

Background: Early changes in the large muscular arteries are already associated with risk factors as hypertension and obesity in adolescence and young adulthood. The present study examines the association between arterial stiffness measurements, pulse wave velocity and augmentation index and lifestyle-related factors, body composition and cardiorespiratory fitness, in young, healthy, Swedish adults.

Design: This study used a population-based cross-sectional sample.

Methods: The 834 participants in the study were self-reported healthy, non-smoking, age 18-25 years. Augmentation index and pulse wave velocity were measured with applanation tonometry. Cardiorespiratory fitness was measured by ergometer bike test to estimate maximal oxygen uptake. Body mass index (kg/m(2)) was calculated and categorised according to classification by the World Health Organisation.

Results: Young Swedish adults with obesity and low cardiorespiratory fitness have significantly higher pulse wave velocity and augmentation index than non-obese young adults with medium or high cardiorespiratory fitness. The observed U-shaped association between pulse wave velocity and body mass index categories in women indicates that it might be more beneficial to be normal weight than underweight when assessing the arterial stiffness with pulse wave velocity. The highest mean pulse wave velocity was found in overweight/obese individuals with low cardiorespiratory fitness. The lowest mean pulse wave velocity was found in normal weight individuals with high cardiorespiratory fitness. Cardiorespiratory fitness had a stronger effect than body mass index on arterial stiffness in multiple regression analyses.

Conclusions: The inverse association between cardiorespiratory fitness and arterial stiffness is observed already in young adults. The study result highlights the importance of high cardiorespiratory fitness, but also that underweight individuals may be a possible risk group that needs to be further studied.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Arterial stiffness, pulse wave analysis, cardiorespiratory fitness, body mass index, young adult, atherosclerosis
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-62511 (URN)10.1177/2047487317720796 (DOI)000414856300004 ()28696134 (PubMedID)2-s2.0-85033405287 (Scopus ID)
Funder
AFA Insurance
Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2019-10-22Bibliographically approved
3. Body composition is a strong predictor of local carotid stiffness in Swedish, young adults: the cross sectional Lifestyle, biomarkers, and atherosclerosis study
Open this publication in new window or tab >>Body composition is a strong predictor of local carotid stiffness in Swedish, young adults: the cross sectional Lifestyle, biomarkers, and atherosclerosis study
2019 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 19, no 1, article id 205Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Obesity has nearly tripled worldwide during the last four decades, especially in young adults, and is of growing concern since it is a risk factor for cardiovascular diseases (CVD). We explored how different body composition measurements are associated with intima media thickness (cIMT) and local stiffness in the common carotid artery, in a subsample of healthy, young women and men, from the Swedish Lifestyle, Biomarkers, and Atherosclerosis (LBA) Study.

METHODS: From the LBA study, a subsample of 220 randomly selected, self-reported healthy individuals, 18-25 years old, were collected for the automatized local stiffness measurements; arterial distensibility, Young's elastic modulus, and β stiffness index. Blood pressure and mean arterial pressure (MAP) was measured using automatic blood pressure equipment. Body mass index (BMI) was calculated, waist circumference was measured, and percentage of body fat assessed using an impedance body composition analyzer. The carotid artery was scanned by ultrasound and analyzed using B-mode edge wall tracking. cIMT was measured and local stiffness measurements were calculated with carotid blood pressure, measured with applanation tonometry.

RESULTS: No association was found between cIMT and body composition. Local carotid stiffness was associated with body composition, and women had less stiff arteries than men (p < 0.001). Of the local stiffness measurements, arterial distensibility had the strongest associations with body composition measurements in both women and men (p < 0.05). Multiple regression analyses showed that BMI in women and BMI and percentage of body fat in men had the highest impact on arterial distensibility (p < 0.01 in both women and men).

CONCLUSIONS: Arterial distensibility was the local stiffness measurement with the strongest associations to different body composition measurements, in both women and men. In this age group, body composition measurements seem to be stronger predictors of common carotid arterial stiffness than MAP, and is a convenient way of detecting young adults who need cardiovascular risk follow-up and lifestyle counseling.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Arterial distensibility, Arterial stiffness, Body composition, Carotid artery, Cross-sectional study, Epidemiological, Intima media thickness, Young adults
National Category
Nutrition and Dietetics Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-76105 (URN)10.1186/s12872-019-1180-6 (DOI)000483032600001 ()31455254 (PubMedID)2-s2.0-85071644915 (Scopus ID)
Note

Funding Agency:

Asset Management Arm (AFA)  130275

Available from: 2019-09-10 Created: 2019-09-10 Last updated: 2019-10-22Bibliographically approved
4. Higher total physical activity is associated with lower arterial stiffness in Swedish, young adults: The Lifestyle, Biomarkers, and Atherosclerosis study
Open this publication in new window or tab >>Higher total physical activity is associated with lower arterial stiffness in Swedish, young adults: The Lifestyle, Biomarkers, and Atherosclerosis study
(English)Manuscript (preprint) (Other academic)
National Category
Other Basic Medicine
Identifiers
urn:nbn:se:oru:diva-77488 (URN)
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-22Bibliographically approved

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