The effects of weight loss using dietary manipulation and rimonabant therapy on arterial stiffness in type 2 diabetes

摘要

Background: Obesity is considered an important factor contributing to premature arterial stiffening in type 2 diabetes but it is uncertain whether weight loss through dietary modification leads to a reduction in arterial stiffness. Rimonabant is an anti-obesity drug which, through its pharmacological action of cannabinoid receptor blockade, could exert effects on central haemodynamics. Methods: In an open design, 29 obese subjects with type 2 diabetes were studied. Subjects were studied before, during and after 6 months dietary intervention with (20 subjects), or without (9 subjects) rimonabant. Arterial stiffness (aortic and brachial pulse wave velocity), central aortic pressure and wave reflection were assessed non-invasively (Sphygmocor). Results: After 6 months (in comparison with baseline), there were reductions in weight (104 +- 21 versus 107 +- 21 Kg, p < 0.001), and improvements in HbA1c (7.3 +- 1.4 at 3 months, p < 0.01 and 7.4 +- 1.5 at 6 months, p = 0.06 versus 7.7 +-1.5% at baseline) and HDL cholesterol (1.3 +- 0.2 versus 1.2 +- 0.3 mmol/L, p < 0.001). Aortic diastolic pressure (82 +- 10 versus 85 +- 8 mmHg, p < 0.05) was lowered despite unchanged peripheral mean arterial pressure. No reductions in aortic stiffness or wave reflection were observed. Conclusion: Dietary manipulation led to significant weight loss and favourable metabolic effects. These beneficial changes did not lead to a reduction in aortic stiffness or pressure wave reflection despite a fall in central aortic blood pressure.