Elevated pulse pressure may predict future CAD in diabetics
MedWire News: Israeli researchers suggest that an elevated pulse pressure may indicate the presence of pre-clinical coronary artery disease (CAD) in patients with diabetes.
David Halon (Lady Davis Carmel Medical Center, Haifa) and team say: "In the search for simple effective population screening tests for detecting pre-clinical CAD in the increasingly large population of patients with diabetes mellitus, an elevated pulse pressure may prove to be a simple and useful early indication of the need to intensify preventive medical therapy."
As reported in the International Journal of Cardiology, the team calculated the brachial pulse pressures of 423 diabetic patients with no known history of CAD.
Coronary computed tomographic angiography (CCTA) scans identified existing coronary artery atheroma in 76.6% of the patients.
In 55.1% of these patients, the atheroma was present in multiple coronary vessels, and in 22.9% of patients luminal stenosis of greater than or equal to 50% of vessel diameter was detected.
The median pulse pressure of all patients was 58.5 mmHg.
After adjustment for mean blood pressure (BP), pulse pressure was significantly higher among patients with coronary atheroma than in those without coronary artery atheroma.
Pulse pressure was also found to positively correlate with the number of coronary arteries with atheroma.
Even after adjusting for Framingham and UK Prospective Diabetic Study risk scores, the risk for coronary atheroma among those with elevated pulse pressure remained increased by 17% compared with those without an elevated pulse pressure.
After adjusting for age, gender, mean BP, and heart rate, each 10-mmHg increase in pulse pressure was associated with a 19% increase in risk for multivessel coronary atheroma.
Further analysis showed that pulse pressure correlated positively with quartiles of coronary artery calcium scores among these patients.
Even after adjustment for age, gender, and mean BP, this correlation remained significant.
The researchers write: "The correlation coefficients were relatively low confirming that many factors other than pulse pressure are responsible for the appearance of coronary arterial plaque."
They add: "However, few of these factors can be so readily and simply measured as pulse pressure."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Lauretta Ihonor