Pulse pressure predicts cardiovascular risk in patients with type 2 diabetes mellitus.
BACKGROUND
Pulse pressure (PP), a marker of arterial stiffness, is a better predictor of coronary heart disease (CHD) risk than systolic blood pressure (SBP) or diastolic blood pressure (DBP) in older adults. Whether this is also true in subjects with type 2 diabetes, who are at increased risk for cardiovascular disease, is unknown.


METHODS
Data on 2911 type 2 diabetic subjects relating to blood pressure (BP), other risk factors, and cardiovascular events were abstracted from The Cardiff Diabetes Database. Logistic regression was used to assess the relationship among BP components and the risk of CHD, cerebrovascular (CVD), and peripheral vascular (PVD) events after correction for age, gender, cholesterol, and smoking status.


RESULTS
In the 4-year follow-up period there were 574 CHD, 168 CVD, and 157 PVD events. Both PP and SBP, but not DBP, were positively associated with the risk of all event types. However, PP emerged as the best predictor of CHD events, and SBP as the best predictor of CVD and PVD events. Total and HDL-cholesterol were the most important variables associated with PP after age.


CONCLUSIONS
In summary, PP is a better predictor of CHD events than SBP in persons with type 2 diabetes, but the converse is true for CVD and PVD.
Cockcroft
John R
JR
Department of Cardiology, University of Wales College of Medicine, University Hospital, Cardiff, Wales. cockcroftjr@cf.ac.uk
Wilkinson
Ian B
IB
Evans
Marc
M
McEwan
Philip
P
Peters
John R
JR
Davies
Steve
S
Scanlon
Maurice F
MF
Currie
Craig J
CJ
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000503:physiopathology; D003327:Coronary Disease / Q000209:etiology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011673:Pulsatile Flow / Q000502:physiology*; D011674:Pulse; D012307:Risk Factors