Association of double product and pulse pressure with cardiovascular and all-cause mortality in the LURIC study

Area of Science:

• Cardiology
• Vascular Health
• Predictive Analytics

Background:

• Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) are established risk factors for cardiovascular mortality (CVM).
• Pulse pressure (PP) serves as an accessible marker of vascular stiffness, and double product (DP) indicates cardiac workload.
• The predictive capabilities of PP and DP for CVM require further investigation in diverse patient cohorts.

Purpose of the Study:

• To evaluate the predictive value of pulse pressure (PP) and double product (DP) for cardiovascular mortality (CVM).
• To compare the predictive performance of PP and DP against traditional markers like SBP and MAP.
• To assess the independent predictive power of PP and DP in a multivariate model, considering factors like age, sex, BMI, diabetes, and eGFR.

Main Methods:

• Analysis of data from the Ludwigshafen Risk and Cardiovascular Health study, a monocentric cohort of 3316 patients undergoing coronary angiography.
• Calculation of hazard ratios (HRs) for CVM associated with increases in SBP, PP, and DP.
• Multivariate regression analysis adjusted for various clinical and demographic factors to determine independent predictors of CVM.

Main Results:

• An increase in SBP or PP by 1 mmHg significantly elevated CVM risk (HRs 1.009 and 1.016, respectively).
• A 100 mmHg/min increase in DP was associated with a 1.010 higher risk of CVM.
• PP and DP demonstrated superior prediction of CVM compared to SBP or MAP in patients with coronary artery disease (CAD) and heart failure (HF).
• In multivariate analysis, DP and heart rate (HR) remained significant predictors of CVM, while PP did not, likely due to widespread antihypertensive treatment.
• PP was associated with age, diabetes, obesity, and impaired renal function.

Conclusions:

• Pulse pressure (PP) and double product (DP) are potent predictors of cardiovascular and all-cause mortality in a population at medium- to high-risk for cardiovascular disease (CVD).
• DP is an independent predictor of both cardiovascular and all-cause mortality, even after multivariate adjustment.
• While PP is associated with various risk factors, its independent predictive value for CVM may be diminished in cohorts with high rates of antihypertensive treatment.