Adiposity has no direct effect on carotid intima-media thickness in adolescents and young adults: Use of structural equation modeling to elucidate indirectdirect pathways

Autor: Elaine M. Urbina, Philip R. Khoury, Amy S. Shah, Zhiqian Gao, Lawrence M. Dolan, Connie E McCoy, Thomas R. Kimball
Rok vydání: 2015
Předmět:
Carotid Artery Diseases
Male
Blood Pressure
Comorbidity
030204 cardiovascular system & hematology
Carotid Intima-Media Thickness
Body Mass Index
0302 clinical medicine
Risk Factors
Prevalence
Young adult
Child
Adiposity
Age Factors
Carotid Arteries
Cohort
Hypertension
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Adolescent
030209 endocrinology & metabolism
Vascular Remodeling
Risk Assessment
Article
03 medical and health sciences
Young Adult
Predictive Value of Tests
Internal medicine
medicine
Humans
cardiovascular diseases
Obesity
Ohio
Chi-Square Distribution
business.industry
Type 2 Diabetes Mellitus
Anthropometry
medicine.disease
Blood pressure
Endocrinology
Cross-Sectional Studies
Intima-media thickness
Diabetes Mellitus
Type 2
Multivariate Analysis
Linear Models
business
Body mass index
Zdroj: Atherosclerosis. 246
ISSN: 1879-1484
Popis: Background Carotid intima-media thickness (cIMT) is associated with CV events in adults. Thicker cIMT is found in youth with CV risk factors including obesity. Which risk factors have the most effect upon cIMT in youth and whether obesity has direct or indirect effects is not known. We used structural equation modeling to elucidate direct and indirect pathways through which obesity and other risk factors were associated with cIMT. Methods We collected demographics, anthropometrics and laboratory data on 784 subjects age 10–24 years (mean 18.0 ± 3.3 years). Common, bulb and internal carotid cIMT were measured by ultrasound. Multivariable regression analysis was performed to assess independent determinants of cIMT. Analyses were repeated with structural equation modeling to determine direct and indirect effects. Results Multivariable regression models explained 11%–22% of variation of cIMT. Age, sex and systolic blood pressure (BP) z-score were significant determinants of all cIMT segments. Body mass index (BMI) z-score, race, presence of type 2 diabetes mellitus (T2DM), hemoglobin A1c (HbA1c) and non-HDL were significant for some segments (all p = 0.05). The largest direct effect on cIMT was age (0.312) followed by BP (0.228), Blood glucose control (0.108) and non-HDL (0.134). BMI only had a significant indirect effect through blood glucose control, BP & non-HDL. High sensitivity C-reactive protein (CRP) had a small indirect effect through blood glucose control (all p = 0.05). Conclusions Age and BP are the major factors with direct effect on cIMT. Glucose and non-HDL were also important in this cohort with a high prevalence of T2DM. BMI only has indirect effects, through other risk factors. Traditional CV risk factors have important direct effects on cIMT in the young, but adiposity exerts its influence only through other CV risk factors.
Databáze: OpenAIRE
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