A systematic review and network meta-analysis.
VIEW MORE OF ENDO 2019 Obes Rev. 2019 Mar 18. doi: 10.1111/obr.12831. [Epub ahead of print] The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta-analysis. Loader J1,2,3, Khouri C4,5, Taylor F2, Stewart S6, Lorenzen C7, Cracowski JL4,5, Walther G3,7, Roustit M4,5. Author information 1 Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia.2 Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.3 LAPEC EA4278, Avignon Université, Avignon, France.4 Inserm U1042, Université Grenoble Alpes, Grenoble, France.5 Clinical Pharmacology, Grenoble Alpes University Hospital, Grenoble, France.6 Hatter Institute for Reducing Cardiovascular Disease in Africa, The University of Cape Town, Cape Town, South Africa.7 School of Exercise Science, Australian Catholic University, Melbourne, Australia. Abstract 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. © 2019 World Obesity Federation. KEYWORDS: endothelial dysfunction; insulin resistance; obesity; vascular function PMID:30887713