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

Abstract 

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.

Keywords: Diabetes, Arterial stiffness, Obesity