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Nonlinear relation between pulse pressure and coronary heart disease in patients with type 2 diabetes or hypertension
Arash A Nargesi1, Sadaf Esteghamati, Behnam Heidari
1Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Insights
The relationship between pulse pressure (PP) and coronary heart disease (CHD) is nonlinear in patients with diabetes and hypertension. Both low and high PP increase CHD risk, with wide PP being an independent risk factor.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Wide pulse pressure (PP) is a known predictor of coronary heart disease (CHD).
- The linearity of the association between PP and CHD has not been previously investigated.
- Patients with type 2 diabetes and/or hypertension are at increased risk for cardiovascular events.
Purpose of the Study:
- To examine the relationship between pulse pressure and the incidence of coronary heart disease.
- To determine if the association between pulse pressure and coronary heart disease is linear or nonlinear.
- To investigate this relationship specifically in patients with type 2 diabetes and/or hypertension.
Main Methods:
- A cohort of 3120 patients (2607 with diabetes, 1586 with hypertension) was followed for 7.8 years.
- Physician-adjudicated first hard coronary heart disease events served as the primary outcome.
- Cox regression and restricted cubic splines were employed to analyze the association between PP and incident CHD, assessing nonlinearity.
Main Results:
- The null hypothesis of a linear relationship between PP and CHD was rejected (P=0.004), indicating a nonlinear association.
- Both narrow (<45 mmHg) and wide (>55 mmHg) pulse pressures were associated with an increased risk of future CHD events compared to PP between 45-55 mmHg.
- The association between wide PP and CHD remained significant after adjusting for systolic, diastolic, or mean arterial pressures, but was attenuated by traditional cardiovascular risk factors like age.
Conclusions:
- The relationship between pulse pressure and coronary heart disease is nonlinear in patients with type 2 diabetes and hypertension.
- Both narrow and wide pulse pressures are linked to an increased risk of future hard CHD events.
- The association between wide pulse pressure and CHD is independent of systolic, diastolic, or mean arterial pressure.
Objectives:
Wide pulse pressure (PP) is an independent predictor of coronary heart disease (CHD). However, the linearity of the relation between PP and CHD was not examined before. We aimed to examine this relation in patients with type 2 diabetes and/or hypertension.
Methods:
A total of 3120 patients (including 2607 with diabetes and 1586 with hypertension) were followed for 7.8 years. Physician-adjudicated first hard CHD event was the primary outcome. Cox regression analysis was used to investigate the association between PP and incident CHD. Restricted cubic splines were used to investigate nonlinear relations.
Results:
Four spline covariates were defined between 30, 40, 50, 60, and 70 mmHg. The null-hypothesis of the linearity of the relation between PP and CHD was rejected (P value = 0.004). The second, third, and fourth spline covariates were significant (P value = 0.02, P value = 0.02 and P value = 0.01, respectively), supporting a nonlinear relation in corresponding PP intervals. Patients with PP less than 45 mmHg and PP more than 55 mmHg had increased risk of future CHD event, compared with those with PP between 45 and 55 mmHg [hazard ratio (HR) = 1.33 (1.00-1.77) and HR = 1.67 (1.23-2.27), respectively]. This remained significant after controlling for systolic, diastolic, or mean arterial pressures in wide PP group. However, adjustment for traditional cardiovascular risk factors (especially age) attenuated the relation in those with wide PP.
Conclusion:
The relation between PP and CHD is nonlinear in patients with type 2 diabetes and hypertension. Both narrow and wide PPs increase risk of future hard CHD events. The association between wide PP and CHD is independent from SBP, DBP, or mean arterial pressure.
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