The association of the Friesinger score and pulse pressure in an urban South Asian patient population: pulse pressure,an independent predictor of coronary artery disease |
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| Authors: | Fahad Javed Emad F Aziz Girish N Nadkarni Shahzeb A Khan Manpreet Singh Sabharwal Rishi Malhan Alexandre Benjo Eyal Herzog Franz H Messerli |
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| Institution: | 1. St. Luke''s-Roosevelt Hospital Center, University Hospital of College of Physicians and Surgeons of Columbia University, New York, NY;2. Department of Medicine/Pediatrics, Wayne State University, Detroit, MI;1. Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA;2. Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA;3. Division of General Internal Medicine, Weill Cornell Medical College, New York, NY, USA;4. Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA;1. Division of Endocrinology, Diabetes, and Bone Diseases, Icahn School of Medicine at Mount Sinai, Box 1055, New York, NY 10029, USA;2. Mount Sinai Heart, Icahn School of Medicine, Box 1014, 1 Gustave Levy Place, New York, NY 10029-6574, USA;1. INSERM, U906, faculté de médecine Timone, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France;2. Aix Marseille university, faculté de médecine Timone, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France;3. Laboratoire de parasitologie-mycologie, CHU de Marseille, AP–HP de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France;4. Hunan Institute of Parasitic Diseases, 436, Jine Middle Road, Yueyang city, 414000 Hunan Province, China;1. School of Medicine, Universidad Espíritu Santo – Ecuador, Guayaquil, Ecuador;2. Department of Neurological Sciences, Hospital-Clínica Kennedy, Guayaquil 0901, Ecuador;3. Gastroenterology Department, Vanderbilt University, Nashville, TN, USA;4. Community Center, The Atahualpa Project, Atahualpa, Ecuador;5. Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA;1. New Jersey Institute of Technology, Department of Physics, Newark, NJ 07102, USA;2. New Jersey Institute of Technology, Department of Chemistry and Environmental Science, Newark, NJ 07102, USA |
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| Abstract: | Increase in pulse pressure has been shown to be predisposing factor for Coronary Artery Disease (CAD) in diverse patient populations but its relationship with the severity of CAD, particularly in the South Asians immigrant population of United States has not been demonstrated. We performed a single-center, cross-sectional study. Pulse pressure was calculated by the difference between the systolic and diastolic brachial blood pressures, and the Friesinger score (FS) was used to quantify the severity of CAD with the score of 5 used as a cutoff for extensive disease. We also sought to assess the correlation between the Friesinger score and the 10-year cardiovascular event (CVD) risk as calculated by the Framingham score. Odds ratios and 95% confidence intervals for the associations between explanatory variables and a high Friesinger score were estimated using multivariate logistic regression models. P values below .05 were considered to be statistically significant. Statistical analysis was performed using STATA version 10 software package (College Station, TX). The mean pulse pressure was significantly higher in participants with an FS of ≥5 compared with participants with an FS of <5 (63 vs. 46 mm Hg; P = .004). In univariate analysis, a pulse pressure ≥40 mm Hg was associated with a five-fold increased odds of a higher FS compared with a pulse pressure <40 mm Hg (P = .039), which was unchanged in multivariate analysis. In multivariate analysis, even after adjustment for presence of hypertension, a 10 mm Hg increase in pulse pressure was associated with a 1.97-fold increased odds of a higher FS (95% CI 1.22–3.71, P = .009). The mean Framingham score was higher in participants with a higher FS, but this difference was not significant (32.7 vs. 20.3; P = .1139). Our study demonstrates that pulse pressure, a well-established marker of vascular health, is a significant independent predictor of the severity of CAD as assessed by coronary angiography in South Asians. |
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