Pulse Pressure Predicts Incident Cardiovascular Disease but Not Diabetic Nephropathy in Patients With Type 1 Diabetes (The FinnDiane Study)
- Daniel Gordin, MD, DMSC1,2,
- Johan Wadén, MD1,2,
- Carol Forsblom, DMSC1,2,
- Lena Thorn, MD, DMSC1,2,
- Milla Rosengård-Bärlund, MD1,2,
- Nina Tolonen, MD1,2,
- Markku Saraheimo, MD, DMSC1,2,
- Valma Harjutsalo, PHD1,
- Per-Henrik Groop, MD, DMSC1,2,3 and
- for the FinnDiane Study Group*
- 1Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland
- 2Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Finland
- 3The Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Corresponding author: Per-Henrik Groop, .
OBJECTIVE Pulse pressure (PP), an estimate of arterial stiffness, has been shown to be associated with incident cardiovascular disease (CVD) in patients with type 1 diabetes (T1D). However, diabetic kidney disease, a strong predictor of CVD, was not previously taken into account. Furthermore, the role of PP as a predictor of diabetic nephropathy is not known. Therefore, we prospectively investigated the associations between PP and these diabetic complications in patients with T1D.
RESEARCH DESIGN AND METHODS A total of 4,509 patients from the FinnDiane Study participated. Follow-up data on incident CVD events and renal status (median 5.3 years) were available in 69 and 76% of the patients, respectively. Altogether, 269 patients (8.6%) had an incident CVD event and 370 patients (10.8%) progressed to a higher level of albuminuria or to end-stage renal disease.
RESULTS PP was higher at baseline in patients who experienced a CVD event (66 ± 18 vs. 52 ± 14 mmHg; P < 0.001) or progressed in their renal status (58 ± 18 vs. 54 ± 15 mmHg; P < 0.01) during follow-up. In a Cox regression model, PP was independently associated with a first ever CVD event (hazard ratio per 10 mmHg 1.22 [95% CI 1.10–1.34]) but not progression of renal disease (1.00 [0.89–1.12]) after adjustments for traditional risk factors.
CONCLUSIONS PP, a marker of arterial stiffness, is a risk factor for cardiovascular complications but not for diabetic nephropathy in patients with T1D.
↵* A complete list of the members of the FinnDiane Study Group can be found in the Supplementary Data.
- Received October 25, 2010.
- Accepted January 13, 2011.
- © 2011 by the American Diabetes Association.
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