TY - JOUR
T1 - The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health
T2 - A systematic review and network meta-analysis
AU - Loader, Jordan
AU - Khouri, Charles
AU - Taylor, Frances
AU - Stewart, Simon
AU - Lorenzen, Christian
AU - Cracowski, Jean Luc
AU - Walther, Guillaume
AU - Roustit, Matthieu
PY - 2019/6/1
Y1 - 2019/6/1
N2 - This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (−0.41%, 95% CI, −0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (−4.26%, 95% CI, −4.97 to −3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes.
AB - This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (−0.41%, 95% CI, −0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (−4.26%, 95% CI, −4.97 to −3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes.
KW - endothelial dysfunction
KW - insulin resistance
KW - obesity
KW - vascular function
UR - http://www.scopus.com/inward/record.url?scp=85065859456&partnerID=8YFLogxK
U2 - 10.1111/obr.12831
DO - 10.1111/obr.12831
M3 - Review article
C2 - 30887713
AN - SCOPUS:85065859456
VL - 20
SP - 906
EP - 920
JO - Obesity Reviews
JF - Obesity Reviews
SN - 1467-7881
IS - 6
ER -