Cardiovascular risk assessment using pulse pressure in the first national health and nutrition examination survey
1Clinical Trials Group, National Heart, Lung, and Blood Institute, Bethesda, Md, USA.
Insights
Elevated pulse pressure, a measure of arterial stiffness, independently predicts increased risk of cardiovascular and all-cause mortality in the general US population. This finding highlights pulse pressure as a crucial prognostic marker beyond traditional risk factors.
Area of Science:
- Cardiovascular epidemiology
- Vascular physiology
- Public health
Background:
- Increased arterial stiffness, indicated by elevated pulse pressure, is linked to higher mortality.
- Previous studies often lacked populations representative of the general US population.
- The First National Health and Nutrition Examination Survey (NHANES I) provides a representative cohort free of cardiovascular disease.
Purpose of the Study:
- To assess and quantify the increased risk of death associated with elevated pulse pressure.
- To determine the value of adding pulse pressure to standard cardiovascular disease risk factors.
- To evaluate pulse pressure as an independent predictor of mortality in a US-representative population.
Main Methods:
- Analysis of a cohort of 5771 subjects from NHANES I with a mean follow-up of 16.5 years.
- Utilized SUDAAN for Cox proportional regression and logistic regression in complex, weighted samples.
- Assessed pulse pressure's predictive value alongside traditional cardiovascular risk factors.
Main Results:
- Pulse pressure independently predicted increased risk of cardiovascular disease death, coronary heart disease death, and all-cause mortality.
- A 10 mm Hg increase in pulse pressure was associated with a 26% increased risk of cardiovascular death in younger adults (25-45) and 10% in older adults (46-77).
- Pulse pressure provided prognostic information beyond established risk factors, including hypertension classification.
Conclusions:
- Elevated pulse pressure is an independent predictor of mortality in a US-representative population.
- Pulse pressure may serve as a marker for the extent of vascular disease.
- Incorporating pulse pressure assessment can enhance cardiovascular risk prediction.
Abstract:
Increased stiffness of the conduit arteries has been associated with increased risk of death and cardiovascular death in a number of populations. None of these populations, however, are fully representative of the US population. The cohort examined in the First National Health and Nutrition Examination Survey (NHANES I) that was free of overt cardiovascular disease was selected to be representative of the US population. We assessed and quantified the increased risk of death associated with elevated pulse pressure in this population. A cohort of 5771 subjects from NHANES I was used to determine the value of adding pulse pressure to standard cardiovascular disease risk factors for assessment of the risk of death during a mean follow-up period of 16.5 years. Analyses were performed by use of the SUDAAN statistical package for performing Cox proportional regression, logistic regression, and other standard methods in complex, weighted samples. Pulse pressure increased with increasing age, body mass index, cholesterol level, and mean arterial pressure. With increasing pulse pressure, the percentage of cigarette smokers decreased and the percentage of diabetics increased. Despite these associations with known risk factors, pulse pressure was independently predictive of an increased risk of death from cardiovascular disease, coronary heart disease, and all-cause mortality. It provides independent prognostic information beyond that provided by known risk factors that were evaluated in this study, including the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure hypertension classification. A 10 mm Hg increase in pulse pressure in persons 25 to 45 of age was associated with a 26% increase in risk of cardiovascular death (95% confidence interval [CI], 5 to 50) and with an 10% increase (95% CI, 2 to 19) in persons 46 to 77 years of age. In a cohort designed to be representative of the US population, elevated pulse pressure has been shown to provide independent prognostic information. This variable may be a marker for the extent of vascular disease and may contribute to the occurrence of clinical events.
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