Yonsei Med J.  2005 Aug;46(4):511-518. 10.3349/ymj.2005.46.4.511.

Reduction in Visceral Adiposity is Highly Related to Improvement in Vascular Endothelial Dysfunction among Obese Women: An Assessment of Endothelial Function by Radial Artery Pulse Wave Analysis

Affiliations
  • 1Department of Cardiology and Ewha Medical Research Institute, College of Medicine, Ewha Womans University, Seoul, Korea. sihoon@ewha.ac.kr
  • 2Department of Family Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.

Abstract

Because obesity is frequently complicated by other cardiovascular risk factors, the impact of a reduction in visceral adiposity on vascular endothelial dysfunction (VED) in obese patients is difficult to determine. In the present study, we evaluated the impact of a reduction in visceral adiposity on VED in obese women. Thirty-six premenopausal obese women (BMI > or = 25 kg/m2) without complications were enrolled in the study. VED was evaluated by determining the augmentation index (AIx) from radial artery pulse waves obtained by applanation tonometry. Changes in AIx in response to nitroglycerin- induced endothelium-independent vasodilatation (delta AIx-NTG) and in response to salbutamol administration (delta AIx-Salb) were determined before and after weight reduction. After a 12-week weight reduction program, the average weight loss was 7.96 +/- 3.47 kg, with losses of 21.88 +/- 20.39 cm2 in visceral fat areas (p < 0.001). Pulse wave analysis combined with provocative pharmacological testing demonstrated preserved endothelium-independent vasodilation in healthy premenopausal obese women (delta AIx-NTG: 31.36 +/- 9.80% before weight reduction vs. 28.25 +/- 11.21% after weight reduction, p > 0.1) and an improvement in endothelial-dependent vasodilation following weight reduction (delta AIx-Salb: 10.03 +/- 6.49% before weight reduction vs. 19.33 +/- 9.28% after reduction, p < 0.001). A reduction in visceral adipose tissue was found to be most significantly related to an increase in delta AIx-Salb (beta=-0.57, p < 0.001). A reduction in visceral adiposity was significantly related to an improvement in VED. This finding suggests that reduction of visceral adiposity may be as important as the control of other major risk factors in the prevention of atherosclerosis in obese women.

Keyword

Augmentation index; visceral adiposity; vascular endothelial dysfunction

MeSH Terms

Adipose Tissue/*metabolism
Adult
Endothelium, Vascular/*physiopathology
Female
Humans
Middle Aged
Obesity/*physiopathology
*Pulse
Radial Artery/*physiology
Viscera
Weight Loss

Reference

1. Eckel RH, Krauss RM. American Heart Association call to action: obesity as a major risk factor for coronary heart disease. Circulation. 1998. 37:2099–2100.
2. Terry RB, Page WF, Haskell WL. Waist-hip ratio, body mass index and premature cardiovascular disease mortality in US Army veterans during a twenty-three year follow up study. Int J Obes Relat Metab Disord. 1992. 16:417–423.
3. Tracy RP. Inflammation in cardiovascular disease; cart, horse, or both? Circulation. 1998. 97:2000–2002.
4. Ziccardi P, Nappo F, Giugliano G, Esposito K, Marfella R, Cioffi M, et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation. 2002. 105:804–809.
5. Wilkinson IB, Hall IR, MacCallum H, Mackenzie IS, McEniery CM, van der Arend BJ, et al. Pulse-wave analysis: clinical evaluation of a noninvasive, widely applicable method for assessing endothelial function. Arterioscler Thromb Vasc Biol. 2002. 22:147–152.
6. Hayward CS, Kraidly M, Webb CM, Collins P. Assessment of endothelial function using peripheral waveform analysis. J Am Coll Cardiol. 2002. 40:521–528.
7. Chowienczyk PJ, Kelly RP, MacCallum H, Millasseau SC, Andersson TL, Gosling RG, et al. Photoplethysmographic assessment of pulse wave reflection: blunted response to endothelium-dependent beta 2-adrenergic vasodilation in type II diabetes mellitus. J Am Coll Cardiol. 1999. 34:2007–2014.
8. Suh HS, Park YW, Kang JH, Lee SH, Lee HS, Shim KW. Vascular endothelial dysfunction tested by blunted response to endothelium-dependent vasodilation by salbutamol and its related factors in uncomplicated pre-menopausal obese women. Int J Obes (Lond). 2005. 29:217–222.
9. Shuman WP, Morris LL, Leonetti DL, Wahl PW, Moceri VM, Moss AA, et al. Abdominal body fat distribution detected by computed tomography in diabetic men. Invest Radiol. 1986. 21:483–487.
10. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assesment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentration in man. Diabetologia. 1985. 28:412–419.
11. Dawes M, Chowienczyk PJ, Ritter JM. Effects of inhibition of the L-arginine/NO pathway on beta-adrenergic mediated vasodilation in human forearm vasculature. Circulation. 1997. 95:2293–2297.
12. Kelly R, Hayward C, Avolio A, O'Rourke M. Noninvasive determination of age-related changes in the human arterial pulse. Circulation. 1989. 80:1652–1659.
13. Seger P, Qasem A, DeBacker T, Carlier S, Verdonck P, Avolio A. Peripheral 'oscillatory' compliance is associated with aortic augmentation index. Hypertension. 2001. 37:1434–1439.
14. Mackenzie IS, Wilkinson IB, Cockcroft JR. Assessment of arterial stiffness in clinical practice. QJM. 2002. 95:67–74.
15. Arcaro G, Zamboni M, Rossi L, Turcato E, Covi G, Armellini F, et al. Body fat distribution predicts the degree of endothelial dysfunction in uncomplicated obesity. Int J Obes Relat Metab Disord. 1999. 23:936–942.
16. Hashimoto M, Akishita M, Eto M, Kozaki K, Ako J. The impairment of flow-mediated vasodilatation in obese men with visceral fat accumulation. Int J Obes Relat Metab Disord. 1998. 22:477–484.
17. Montague CT, O'Rahilly S. The perils of portliness: causes and consequences of visceral adiposity. Diabetes. 2000. 49:883–888.
18. Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR Jr, Lerman A. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000. 101:948–954.
19. Hayashi T, Boyko EJ, Leonetti DL, McNeely MJ, Newell-Morris L, Kahn SE, et al. Visceral adiposity is an independent predictor of incident hypertension in Japanese Americans. Ann Intern Med. 2004. 140:992–1000.
20. Chowienczyk PJ, Watts GF, Cockcroft JR, Ritter JM. Impaired endothelium dependent vasodilation of forearm resistance vessels in hypercholesterolaemia. Lancet. 1992. 340:1430–1432.
21. Celermajer DS, Sorensen KE, Spiegelhalter DJ, Georgakopoulos D, Robinson J, Deanfield JE. Aging is associated with endothelial dysfunction in healthy men years before the age-related decline in women. J Am Coll Cardiol. 1994. 24:471–476.
22. Lieberman EH, Gerhard MD, Uehata A, Walsh BW, Selwyn AP, Ganz P, et al. Estrogen improves endothelium-dependent, flow mediated vasodilation in postmenopausal women. Ann Intern Med. 1994. 121:936–941.
23. Clarkson P, Celermajer DS, Donald AE, Sampson M, Sorensen KE, Adams M, et al. Impaired vascular reactivity in insulin-dependent diabetes mellitus is related to disease duration and low density lipoprotein cholesterol levels. J Am Coll Cardiol. 1996. 28:573–579.
24. Vogel RA, Corretti MC, Plotnick GD. Changes in flow-mediated brachial artery vasoactivity with lowering of desirable cholesterol levels in healthy middle-aged men. Am J Cardiol. 1996. 77:37–40.
25. O'Driscoll G, Green D, Taylor RR. Simvastatin, an HMG-coenzyme A reductase inhibitor, improves endothelial function within 1 month. Circulation. 1997. 95:1126–1131.
26. Gerhard M, Walsh BW, Tawakol A, Haley EA, Creager SJ, Seely EW, et al. Estradiol therapy combined with progesterone and endothelium-dependent vasodilation in postmenopausal women. Circulation. 1998. 98:1158–1163.
27. Sorensen KE, Dorup I, Hermann AP, Mosekilde L. Combined hormone replacement therapy does not protect women against the age-related decline in endothelium-dependent vasomotor function. Circulation. 1998. 97:1234–1238.
28. Gill JM, Al-Mamari A, Ferrell WR, Cleland SJ, Packard CJ, Sattar N, et al. Effects of prior moderate exercise on postprandial metabolism and vascular function in lean and centrally obese men. J Am Coll Cardiol. 2004. 21:2375–2382.
29. Anderson TJ, Uehata A, Gerhard MD, Meredith IT. Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol. 1995. 26:1235–1241.
30. Hope SA, Tay DB, Meredith IT, Cameron JD. Use of arterial transfer functions for the derivation of arterial wave form characteristics. J Hypertens. 2003. 21:1299–1305.
31. Lemogoum D, Flores G, Van den Abeele W, Ciarka A, Leeman M, Degaute JP. Validity of pulse pressure and augmentation index as surrogate measures of arterial stiffness during beta-adrenergic stimulation. J Hypertens. 2004. 22:511–517.
32. Williams B. Pulse wave analysis and hypertension: evangelism versus skepticism. J Hypertens. 2004. 22:447–449.
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr