Diabetes, pulse pressure and cardiovascular mortality: the Hoorn Study.
OBJECTIVE
Type 2 diabetic patients have an increased arterial stiffness and a very high risk of cardiovascular death. The present study investigated the relationship between pulse pressure, an indicator of vascular stiffness, and risk of cardiovascular mortality among type 2 diabetic and non-diabetic individuals. Second, we determined the relationship between pulse pressure and its main determinant (i.e. age), and the influence of diabetes and mean arterial pressure on this relationship.


METHODS
We studied a cohort of 2484 individuals including 208 type 2 diabetic patients. Mean age and median follow-up for non-diabetic and diabetic individuals, respectively, were 61 and 66 years, and 8.8 and 8.6 years. One-hundred and sixteen non-diabetic and 34 diabetic individuals died of cardiovascular causes. Relative risks of cardiovascular mortality were estimated by Cox proportional hazards regression adjusted for age, gender and mean arterial pressure.


RESULTS
Pulse pressure was associated with cardiovascular mortality among the diabetic, but not among the non-diabetic individuals [adjusted relative risk (95% confidence interval) per 10 mmHg increase, 1.27 (1.00-1.61) and 0.98 (0.85-1.13), P interaction = 0.07]. Further adjustment for other risk factors gave similar results. The association, at baseline, between age and pulse pressure was dependent on the presence of diabetes (P interaction = 0.03) and on the mean arterial pressure (P interaction< 0.001) (i.e. there was a stronger association when diabetes was present and when mean arterial pressure was higher).


CONCLUSIONS
We conclude that, in type 2 diabetes, pulse pressure is positively associated with cardiovascular mortality. The association between age and pulse pressure is influenced by the presence of type 2 diabetes and by the height of the mean arterial pressure. These findings support the concept of accelerated vascular aging in type 2 diabetes.
Institute for Cardiovascular Research and Department of Internal Medicine, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
Miranda T
MT
Schram
Pieter J
PJ
Kostense
Robert A
RA
Van Dijk
Jacqueline M
JM
Dekker
Giel
G
Nijpels
Lex M
LM
Bouter
Robert J
RJ
Heine
Coen D
CD
Stehouwer
D000368:Aged; D000375:Aging / Q000502:physiology; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2; D003925:Diabetic Angiopathies / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011674:Pulse