A Prognostic Role of Mean 24-h Pulse Pressure Level for Cardiovascular Events in Type 2 Diabetic Subjects Under 60 Years of Age
- Shigeru Nakano, MD,
- Kazunori Konishi, MD,
- Keisuke Furuya, MD,
- Keigo Uehara, MD,
- Makoto Nishizawa, MD,
- Atsushi Nakagawa, MD,
- Toshikazu Kigoshi, MD and
- Kenzo Uchida, MD
- From the Department of Internal Medicine, Division of Endocrinology and Metabolism, Kanazawa Medical University, Uchinada, Ishikawa, Japan
- Address correspondence and reprint requests to Dr. Shigeru Nakano, Division of Endocrinology, Department of Internal Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan. E-mail: nakano-s{at}kanazawa-med.ac.jp
Abstract
OBJECTIVE—To assess the prognostic role of ambulatory 24-h pulse pressure (PP) on various vascular events in relatively young type 2 diabetic subjects under 60 years of age.
RESEARCH DESIGN AND METHODS—In this prospective study, 237 type 2 diabetic subjects without any history of vascular complications were analyzed. After excluding 9 dropout subjects, 228 subjects (mean age, 46 years; 69% men; mean follow-up period, 100 months) entered the study.
RESULTS—Distribution of 24-h PP for all subjects showed left skewed data, indicating that there may be a diabetic subgroup that had a wide PP. Therefore, further analysis was performed by stratifying the diabetic subjects by quartile of 24-h PP. Outcomes for the widest quartile (n = 58; cut point = 53.3 mmHg) was then compared with those from the other narrower quartiles (n = 170). In the diabetic subjects with a wide PP, cardiovascular events occurred more frequently than those in the diabetic subjects with a narrow one (20.7 vs. 4.1%; P < 0.001), resulting in the significant difference in the cumulative incidence of cardiovascular events (P < 0.001, log-rank test), but not cerebrovascular events, between the two subgroups. The Cox model revealed that a wide 24-h PP at baseline independently predicted subsequent cardiovascular events but not cerebrovascular events. By contrast, only duration of diabetes was the risk factor for cerebrovascular events.
CONCLUSIONS—This study showed that a wide 24-h PP is predictive for cardiovascular events in relatively young diabetic subjects.
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted October 7, 2004.
- Received July 22, 2004.
- DIABETES CARE
