title: The association of the Friesinger score and pulse pressure in an urban South Asian patient population: pulse pressure, an independent predictor of coronary artery disease.
abstract: Increase in pulse pressure has been shown to be predisposing factor for Coronary Artery Disease (CAD) in diverse patient populations but its relationship with the severity of CAD, particularly in the South Asians immigrant population of United States has not been demonstrated. We performed a single-center, cross-sectional study. Pulse pressure was calculated by the difference between the systolic and diastolic brachial blood pressures, and the Friesinger score (FS) was used to quantify the severity of CAD with the score of 5 used as a cutoff for extensive disease. We also sought to assess the correlation between the Friesinger score and the 10-year cardiovascular event (CVD) risk as calculated by the Framingham score. Odds ratios and 95% confidence intervals for the associations between explanatory variables and a high Friesinger score were estimated using multivariate logistic regression models. P values below .05 were considered to be statistically significant. Statistical analysis was performed using STATA version 10 software package (College Station, TX). The mean pulse pressure was significantly higher in participants with an FS of > or =5 compared with participants with an FS of <5 (63 vs. 46 mm Hg; P = .004). In univariate analysis, a pulse pressure > or =40 mm Hg was associated with a five-fold increased odds of a higher FS compared with a pulse pressure <40 mm Hg (P = .039), which was unchanged in multivariate analysis. In multivariate analysis, even after adjustment for presence of hypertension, a 10 mm Hg increase in pulse pressure was associated with a 1.97-fold increased odds of a higher FS (95% CI 1.22-3.71, P = .009). The mean Framingham score was higher in participants with a higher FS, but this difference was not significant (32.7 vs. 20.3; P = .1139). Our study demonstrates that pulse pressure, a well-established marker of vascular health, is a significant independent predictor of the severity of CAD as assessed by coronary angiography in South Asians.
authors.affiliation: St. Luke's-Roosevelt Hospital Center, University Hospital of College of Physicians and Surgeons of Columbia University, New York, NY, USA. Fjaved@chpnet.org
authors.forename: Fahad
authors.initials: F
authors.lastname: Javed
authors.forename: Emad F
authors.initials: EF
authors.lastname: Aziz
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
authors.forename: Shahzeb A
authors.initials: SA
authors.lastname: Khan
authors.forename: Manpreet Singh
authors.initials: MS
authors.lastname: Sabharwal
authors.forename: Rishi
authors.initials: R
authors.lastname: Malhan
authors.forename: Alexandre
authors.initials: A
authors.lastname: Benjo
authors.forename: Eyal
authors.initials: E
authors.lastname: Herzog
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
mesh_terms: D001210:Asia, Southeastern / Q000208:ethnology; D001213:Asian; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population