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United States Department of Agriculture

Agricultural Research Service

Research Project: Dietary Guidelines Adherence and Healthy Body Weight Maintenance Title: Metabolic factors, adipose tissue, and plasminogen activator inhibitor-1 levels in Type 2 diabetes

Author
item Raatz, Susan

Submitted to: Arteriosclerosis Thrombosis and Vascular Biology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: April 5, 2011
Publication Date: April 21, 2011
Citation: Raatz, S.K. 2011. Metabolic factors, adipose tissue, and plasminogen activator inhibitor-1 levels in Type 2 diabetes. Arteriosclerosis Thrombosis and Vascular Biology. DOI: 10.1161/ATVBAHA.111.224386.

Interpretive Summary: We examined 1-year changes in markers of blood clotting (PAI-1, D-dimer, and fibrinogen levels), body fat (adipose); fitness; glucose; and lipid levels in ILI in 1817 participants from Look AHEAD, a randomized trial investigating the effects of intensive lifestyle intervention (ILI), compared with usual care, on cardiovascular events in overweight or obese diabetic persons. PAI-1 levels decreased 29% with ILI and 2.5% with usual care (P<0.0001). Improvements in fitness, glucose control, and high-density lipoprotein cholesterol were associated with decreased PAI-1, independently of weight loss (P=0.03 for fitness, P<0.0001 for others). Reductions in PAI-1 levels with Intensive Lifestyle Intervention in obese diabetic individuals resulted in reductions in PAI-1 levels which may reflect an improvement in adipose tissue health that could reduce cardiovascular disease risk.

Technical Abstract: Plasminogen activator inhibitor-1 (PAI-1) production by adipose tissue is increased in obesity, and its circulating levels are high in type 2 diabetes. PAI-1 increases cardiovascular risk by favoring clot stability, interfering with vascular remodeling, or both. We investigated in obese diabetic persons whether an intensive lifestyle intervention for weight loss (ILI) would decrease PAI-1 levels independently of weight loss and whether PAI-1 reduction would be associated with changes in fibrinogen, an acute phase reactant, or fibrin fragment D-dimer (D-dimer), a marker of ambient coagulation balance. We examined 1-year changes in PAI-1, D-dimer, and fibrinogen levels; adiposity; fitness; glucose; and lipid control with ILI in 1817 participants from Look AHEAD, a randomized trial investigating the effects of ILI, compared with usual care, on cardiovascular events in overweight or obese diabetic persons. Median PAI-1 levels decreased 29% with ILI and 2.5% with usual care (P<0.0001). Improvements in fitness, glucose control, and high-density lipoprotein cholesterol were associated with decreased PAI-1, independently of weight loss (P=0.03 for fitness, P<0.0001 for others). Fibrinogen and D-dimer remained unchanged. Reductions in PAI-1 levels with ILI in obese diabetic individuals may reflect an improvement in adipose tissue health that could affect cardiovascular risk without changing fibrinogen or D-dimer levels.

Last Modified: 12/22/2014
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