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August 3, 2020
Recent research suggests that obesity, type 2 diabetes, and high blood pressure increase teenagers' risk of premature aging of blood vessels (before age 55 for males and before age 65 for females).
Teenagers with any of these three health problems are more likely to develop thicker, stiffer blood vessels—especially the carotid artery—than teens who do not have these conditions. The carotid artery, located in the neck, brings blood to the brain. Thickening of the carotid is associated with decreased blood flow, which can lead to higher risk of cardiovascular events such as stroke.
The findings published May 6 in the online version of the Journal of the American Heart Association suggest a greater risk among teens with obesity, type 2 diabetes, or high blood pressure of heart attacks and strokes later in life. These events could occur at an earlier age than teens without risk factors. This new study adds to the evidence of earlier studies showing that the biological processes that precede heart attacks and cardiovascular disease begin in childhood, although they don't generally cause symptoms or lead to disease until middle age or later.
Early aging of blood vessels was more prominent among youths with type 2 diabetes than those with obesity. Risk factors for accelerated early vascular (blood vessel) aging also included male sex and non-white race.
The study by researchers at University of Minnesota, University of Cincinnati, and Louisiana State University involved 141 teens with normal weight, 156 with obesity, and 151 teens with type 2 diabetes. The researchers followed the teens, whose average age was approximately 18 when the study began, for five years.
The researchers determined carotid artery health two ways. The first, non-invasive ultrasound, measured the thickness of the inner two layers of the blood vessel. The second, pulse wave velocity, determined artery thickness by measuring how fast blood flows. Researchers took both measures at the beginning of the study and five years later.
"Our study demonstrates that the slow changes in blood vessels that lead to the development of atherosclerosis begin early in life," said lead study author Justin R. Ryder, Ph.D., an obesity expert at University of Minnesota Medical School. Atherosclerosis is the slow narrowing of the arteries caused by a buildup of fat, cholesterol and other substances and is associated with the natural aging process. It increases the risk of heart attacks, strokes and other cardiovascular events.
Ryder added that obesity should be treated as aggressively as type 2 diabetes because it has the same increased risk for premature aging of the blood vessels, a precursor to cardiovascular diseases in adulthood.
Like obesity, type 2 diabetes and high systolic blood pressure can be improved with continued evaluation and treatment of these conditions to reduce risk of vascular aging. But first these conditions should be identified through screening.
Height and weight, which are necessary for body mass index calculation and obesity screening, are routinely measured during children's and teenagers' well-child physicals. The 2017 recommendations from the U.S. Preventive Services Task Force (USPSTF) urge healthcare practitioners to screen adolescents and refer those with obesity to comprehensive, intensive behavioral interventions to promote improvements in weight [see Screening Tests for Teens: Obesity].
The American Diabetes Association recommends that healthcare providers screen overweight children for diabetes starting at age 10 or at the onset of puberty if the children have two or more additional risk factors, using a fasting blood glucose test, hemoglobin A1c, or 2-hour oral glucose tolerance test. These risk factors include Native American, African American, Latino, Asian American, or Pacific Islander ancestry; having a close relative with the disease; and having conditions or symptoms associated with insulin resistance. Symptoms of insulin resistance include high blood pressure, unhealthy lipid levels, polycystic ovary syndrome, and darkening and thickening of the skin around the neck, underarms, and skin folds [see Screening Tests for Children: Diabetes and Screening Tests for Teens: Diabetes].
High blood pressure for teens is defined differently than it is in adults. In 2017, the American Academy of Pediatrics recommended comparing a teen's blood pressure to tables that take into account what's normal for healthy youths of the same sex and height class. If a teen has blood pressure higher than 90-95% of other youths in their age and height class, then they may have high blood pressure.
The researchers concluded that the study findings provide further evidence to support the importance of prevention and treatment of obesity, type 2 diabetes, and high blood pressure in teens to help delay or prevent premature aging of their blood vessels.