Pulse pressure trajectories and diabetes risk: A gender-specific cohort study

This study aimed to investigate the relationship between pulse pressure (PP) and diabetes incidence, with emphasis on gender-specific differences. A retrospective cohort analysis was conducted involving 51,529 diabetes-free participants from Sir Run Run Shaw Hospital Health Promotion Center between 2017 and 2024. Cox models assessed associations between baseline PP and diabetes risk, while latent class trajectory modeling identified PP patterns over time. Among 1117 (2.2%) incident diabetes cases during a median 1.69-year follow-up, elevated baseline PP was significantly associated with diabetes risk only in females (hazard ratio [HR] = 1.014, 95% confidence interval [CI]: 1.004-1.024). Females in the highest PP category had a 42% increased risk (HR = 1.424, 95% CI: 1.038-1.953) compared with the lowest, whereas no significant association was found in males. Three PP trajectories were identified. Compared with the low-stable group, females in the high-stable group had a 1.759-fold higher diabetes risk (95% CI: 1.178-2.628), while males showed no significant increase (HR = 1.297, 95% CI: 0.974-1.726). Higher baseline PP and stable high PP trajectory show significant correlations with elevated diabetes risk among females, but not in males. These findings underscore the importance of gender-specific approaches in diabetes risk assessment and prevention.