PREDICTIVE SIGNIFICANCE OF ARTERIAL STIFFNESS PARAMETERS IN EVALUATION OF CARDIOMETABOLIC RISK IN OBESITY PATIENTS

Aim. To evaluate a possibility to apply the arterial stiffness parameters as prediction instrument for cardiometabolic risk stratification in obesity patients.

Material and methods. Totally, 274 normotensive males investigated (mean age 44,8±5,0 y.o.), with no clinical signs of cardiovascular disorders and type 2 diabetes, with the SCORE risk <5% and abdominal obesity. The analysis of metabolic risk factors was done, echocardiography, triplex scanning of brachiocephalic arteries, ultrasound assessment of abdominal adipose tissue thickness, bifunctional 24 hour blood pressure monitoring (BP) with assessment of mean 24 hour pulse wave velocity (PWV) in aorta, augmentation index and systolic BP in aorta.

Results. The association revealed, of the arterial stiffness parameters with ultrasound marker of visceral obesity, metabolic risk factors and parameters of cardiovascular remodeling. Patients with the PWV in aorta equal or higher than 75th percentile for respective age (77 m/s for 35-45 y.o. and 8,2 m/s for 46-55 y.o.) were different (comparing to the group in general) by higher rate of hypertrophy existence (28,4% vs 11,7%, p<0,001) and diastolic dysfunction of the left ventricle (42,0% vs 16,8%, p<0,001), hypertrophy of the intima-media of carotid artery (50,0% vs 29,2%, p<0,001), carotid atherosclerosis (48,9% vs 18,2%, p<0,001) and higher prevalence of the persons with the relation of abdominal visceral adipose tissue to subcutaneous fat layer >3,0 (56,8% vs 28,1%, p<0,001).

Conclusion. The “high” values of PWV in aorta for the respective age diapason (77 m/s for 35-45 y.o. and 8,2 m/s for 46-55 y.o.) witness on higher probability of metabolic disorders and subclinical cardiovascular remodeling, hence the higher cardiometabolic risk. Bifunctional BP 24 hour monitoring with the arterial wall stiffness evaluation in obesity patients is more preferable method making for additional information gather for further risk stratification.

1. a. The GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med 2017; 377: 13-27. DOI: 10.1056/NEJMoa1614362.

2. Чумакова Г. А., Веселовская Н. Г. Клиническое значение висцерального ожирения. М.: ГЭОТАР-Медиа, 2016. 200 с. ISBN 978-59704-3988-3.

3. Piepoli М, Hoes А, Agewall S, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2016). European Heart Journal 2016; 37 (29): 231581. DOI: 10.1016/j.atherosclerosis.2016.05.037.

4. Дружилов М. А., Дружилова О. Ю., Отмахов В. В. и др. Значение оценки артериальной жесткости при метаболическом синдроме. Российский кардиологический журнал 2015; 12: 45-9. DOI: 10.15829/1560-4071-2015-12-45-49.

5. Дружилов М. А., Дружилова О. Ю., Отмахов В. В. и др. Альтернативные инструменты прогнозирования сердечно-сосудистого риска при ожирении: акцент на показатели артериальной жесткости. Российский кардиологический журнал 2016; 12: 109-14. DOI: 10.15829/1560-4071-2016-12-109-114.

6. Nilsson P. Early Vascular Ageing — A Concept in Development. European Endocrinology 2015; 11 (1): 26-31. DOI: 10.17925/EE.2015.11.01.26.

7. Дружилов М. А., Кузнецова Т. Ю. Висцеральное ожирение как фактор риска раннего сосудистого старения. Кардиология 2016; 2 (56): 52-6. DOI: 10.18565/cardio.2016.2.52-56.

8. Васюк Ю. А., Иванова С.В., Школьник Е. Л. и др. Согласованное мнение российских экспертов по оценке артериальной жесткости в клинической практике. Кардиоваскулярная терапия и профилактика 2016; 15 (2): 4-19. DOI: 10.15829/1728-8800-2016-2-4-19.

9. Posokhov I. Pulse wave velocity 24-hour monitoring with one-site measurements by oscillometry. Medical Devices: Evidence and Research 2013; 6: 11-5. DOI: 10.2147/ MDER.S42082.

10. Lang R, Badano L, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28: 1-39. DOI: 10.1016/j.echo.2014.10.003.

11. Mauad F, Chagas-Neto F, Benedeti A, et al. Reproducibility of abdominal fat assessment by ultrasound and computed tomography. Radiol Bras 2017; 50 (3): 141-7. DOI: 101590/0100-3984.2016.0023.

12. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of Cardiovascular Events and AllCause Mortality With Arterial Stiffness A Systematic Review and Meta-Analysis. J Am Coll Cardiol 2010; 55: 1318-27. DOI: 10.1016/j.jacc.2009.10.061.

13. Ben-Shlomo Y, Spears M, Boustred C, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2013; 25 (63): 636-46. DOI: 101016/j.jacc.2013.09.063.

14. Van Bortel L, Laurent S, Boutouyrie P, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. Hypertension 2012; 30 (3): 445-8. DOI: 10.1097/HJH.0b013e32834fa8b0.