Low Fitness and High Fatness: The "Double Whammy" on Vascular Health.

Vascular aging is a complex, continuous process that involves alterations in the structural and functional properties of arteries1. Specific to large arteries, vascular aging can broadly manifest as carotid and aortic luminal dilation, endothelial dysfunction, increases in carotid intima-media thickness, as well as central arterial stiffening1. Importantly, increases in central arterial stiffness contribute to an augmentation of central blood pressure, via an early return of reflected waves from peripheral sites, as well as microcirculatory end-organ damage, via excess transmission of pressure pulsatility that may ultimately increase cardiovascular disease (CVD) risks1. While there are likely several risk factors that may contribute to accelerated vascular aging and increased CVD risks, both reduced cardiorespiratory fitness (CRF)2 and obesity3 are important risk factors that have been independently associated with central arterial stiffening. However, the interactive effects of CRF and obesity on vascular aging remain unclear. In this issue of the Korean Journal of Sports Medicine, Heffernan and Loprinzi4 sought to determine the joint association of CRF and obesity, quantified as the fatness-fitness index (FFI), on estimated pulse wave velocity (ePWV), pulse pressure, and the vascular overload index, all of which are indices of vascular aging that were derived from brachial blood pressure to inform overall vascular burden due to arterial stiffness and blood pressure pulsatility.