title: Pulse pressure predicts incident cardiovascular disease but not diabetic nephropathy in patients with type 1 diabetes (The FinnDiane Study).
abstract: OBJECTIVE
  Pulse pressure (PP), an estimate of arterial stiffness, has been shown to be associated with incident cardiovascular disease (CVD) in patients with type 1 diabetes (T1D). However, diabetic kidney disease, a strong predictor of CVD, was not previously taken into account. Furthermore, the role of PP as a predictor of diabetic nephropathy is not known. Therefore, we prospectively investigated the associations between PP and these diabetes complications in patients with T1D.
  
  
  METHODS
  A total of 4,509 patients from the FinnDiane Study participated. Follow-up data on incident CVD events and renal status (median 5.3 years) were available in 69 and 76% of the patients, respectively. Altogether, 269 patients (8.6%) had an incident CVD event and 370 patients (10.8%) progressed to a higher level of albuminuria or to end-stage renal disease.
  
  
  RESULTS
  PP was higher at baseline in patients who experienced a CVD event (66 ± 18 vs. 52 ± 14 mmHg; P < 0.001) or progressed in their renal status (58 ± 18 vs. 54 ± 15 mmHg; P < 0.01) during follow-up. In a Cox regression model, PP was independently associated with a first ever CVD event (hazard ratio per 10 mmHg 1.22 [95% CI 1.10-1.34]) but not progression of renal disease (1.00 [0.89-1.12]) after adjustments for traditional risk factors.
  
  
  CONCLUSIONS
  PP, a marker of arterial stiffness, is a risk factor for cardiovascular complications but not for diabetic nephropathy in patients with T1D.
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland. per-henrik.groop@helsinki.fi
authors.forename: Daniel
authors.initials: D
authors.lastname: Gordin
authors.forename: Johan
authors.initials: J
authors.lastname: Wadén
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
authors.forename: Lena
authors.initials: L
authors.lastname: Thorn
authors.forename: Milla
authors.initials: M
authors.lastname: Rosengård-Bärlund
authors.forename: Nina
authors.initials: N
authors.lastname: Tolonen
authors.forename: Markku
authors.initials: M
authors.lastname: Saraheimo
authors.forename: Valma
authors.initials: V
authors.lastname: Harjutsalo
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors