Adolescent arterial stiffness -- a novel risk factor for hypertension and insulin resistance

The prevalence of hypertension and obesity has been on the increase globally, despite the targeted effort at promoting weight loss, increasing physical activity, and decreasing sedentary time in the general population. This global challenge informed a recent scientific statement from the American Heart Association on further research into obesity and hypertension in order to mitigate this health burden.

Among middle-aged and older adults, arterial stiffness has been established as a strong predictor of cardiovascular events and all-cause mortality. Hence, a few clinical trials among adults are currently ongoing that examine the likelihood of reversing arterial stiffness. However, among children, adolescents, and young adults, arterial stiffness has been consigned to an intermediate marker of cardiovascular disease and death that occurs in middle age, no thanks to limited longitudinal data and repeated measures of arterial stiffness in a fairly healthy growing young population.

Also, the clinical utility of arterial stiffness as a risk factor for early vascular and metabolic diseases is largely unknown in pediatrics. In this review, recent prospective evidence in a large adolescent population and a middle-aged population that emphasised the value of arterial stiffness as a novel risk factor for hypertension, overweight/obesity, insulin resistance, dyslipidemia, and type 2 diabetes mellitus were summarised. It is often asked what are the risk factors for higher arterial stiffness in adolescents? It is known that maternal smoking habits, early life smoking patterns of adolescents, high salt intake, genetic inheritance, obesity, and elevated blood originating in childhood may contribute to higher arterial stiffening in adolescence.

"Arterial stiffening in adolescence seems to be a subtle, stealthy, but potent risk factor for high blood pressure and metabolic alteration initiating a cascade of biological events finally leading to disease formation such as type 2 diabetes mellitus and premature organ damage. It is therefore expedient for clinicians, pediatricians, public health experts, and policymakers to focus on ways to treat, reduce, and possibly reverse arterial stiffness, particularly from adolescence. An arterial stiffness intervention in adolescence may decrease the incidence of hypertension and metabolic diseases in later life, but further studies are needed," says Andrew Agbaje, a physician and clinical epidemiologist at the University of Eastern Finland.

This study was supported by research grants from Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation sr, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, and the Finnish Foundation for Cardiovascular Research.