title: Sex difference in cardiovascular risk: role of pulse pressure amplification.
abstract: OBJECTIVE
  The study was to explore whether the brachial/carotid pulse pressure (B/C-PP) ratio selectively predicts the sex difference in age-related cardiovascular (CV) death.
  
  
  BACKGROUND
  Hypertension and CV complications are more severe in men and post-menopausal women than in pre-menopausal women. C-PP is lower than B-PP, and the B/C-PP ratio is a physiological marker of PP amplification between B and C arteries that tends toward 1.0 with age.
  
  
  METHODS
  The study involved 72,437 men (ages 41.0 ± 11.1 years) and 52,714 women (39.5 ± 11.6 years). C-PP was calculated for each sex by a multiple regression analysis including B-PP, age, height and risk factors, and a method validated beforehand in a subgroup of 834 subjects. During the 12 years of follow-up, 3,028 men and 969 women died.
  
  
  RESULTS
  In the total population, the adjusted hazard ratios (HR) (95% confidence interval [CI]) of B/C-PP ratio were: 1) for all-cause mortality: men, HR: 1.51 (95% CI: 1.47 to 1.56), women; HR: 2.46 (95% CI: 2.27 to 2.67) (p < 0.0001); and 2) for CV mortality: men, HR 1.81 (95% CI: 1.70 to 1.93); women, HR: 4.46 (95% CI: 3.66 to 5.45) (p < 0.0001). The B/C-PP impact on mortality did not significantly increase from younger men to those ≥ 55 years of age, from: HR: 1.44 (95% CI: 1.31 to 1.58) to HR 1.65 (95% CI: 1.48 to 1.84), but increased significantly with age in women: HR: 3.19 (95% CI: 2.08 to 4.89) versus HR: 5.60 (95% CI: 4.17 to 7.50) (p < 0.01). Thus, the mortality impact of B/C-PP ratio was 3-fold higher in women than in men ≥ 55 years old.
  
  
  CONCLUSIONS
  PP amplification is highly predictive of differences in CV risk between men and women. In post-menopausal women, the attenuation of PP amplification, mainly related to increased aortic stiffness, contributes to the significant increase in CV risk.
authors.affiliation: INSERM, U961, Nancy, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Regnault
authors.forename: Frédérique
authors.initials: F
authors.lastname: Thomas
authors.forename: Michel E
authors.initials: ME
authors.lastname: Safar
authors.forename: Mary
authors.initials: M
authors.lastname: Osborne-Pellegrin
authors.forename: Raouf A
authors.initials: RA
authors.lastname: Khalil
authors.forename: Bruno
authors.initials: B
authors.lastname: Pannier
authors.forename: Patrick
authors.initials: P
authors.lastname: Lacolley
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012727:Sex Characteristics