Combined effects of heart rate and pulse pressure on cardiovascular mortality according to age

OBJECTIVES: The aim of the study was to assess the combined effects of pulse pressure (PP) and heart rate (HR) on cardiovascular mortality in a large French population. DESIGN: The study population was composed of 125,513 men and 96,301 women aged 16-95 years who had a health check-up at the IPC Center between January 1978 and December 1988. Subjects taking antihypertensive treatment were excluded. Mortality was assessed for an 8-year period. HR and PP were classified into three groups. HR groups were: < 60, 60-79 and > or = 80 beats per minute (bpm). PP groups were: < 50, 50-64 and > or = 65 mmHg. RESULTS: In men, PP and HR were both positively associated with cardiovascular mortality risk. In women, mean arterial pressure (MAP) but not PP or HR was associated with cardiovascular mortality. In men, a combined elevation of PP and HR was associated with an important increase of cardiovascular mortality risk. The group with the highest PP and the highest HR had a 4.8-fold increase in cardiovascular mortality risk as compared to the reference group (PP < 50 mmHg and HR < 60 bpm). This effect was more pronounced in younger men (5.4-fold increase) than in older men (3.7-fold increase), as compared to the reference groups of the same age. In women, the combined effects of PP and HR on cardiovascular mortality were not significant. CONCLUSION: A combined elevation of the two components of pulsatile arterial stress is associated with an important increase in cardiovascular mortality in men, especially in younger men. In women, steady-state stress (evaluated primarily by MAP), but not pulsatile stress, is an important determinant of cardiovascular mortality.     

Prevalence and clustering of cardiovascular risk factors among healthy adults in a Chinese population: the MJ Health Screening Center Study in Taiwan

OBJECTIVE: To gain insight into the prevalence and clustering of multiple cardiovascular risk factors in a healthy Chinese adult population in Taiwan. DESIGN: A cross-sectional study was carried out in 1996. SUBJECTS: A total of 46,603 subjects (23,485 men and 23,118 women) who were aged 20--59 y and attended a private health screening center for health examination of their own volition. MEASUREMENTS: Multiple cardiovascular risk factors including cigarette smoking, overweight (23 kg/m(2)< or =body mass index (BMI)<25 kg/m(2)) and obesity (BMI> or =25 kg/m(2)), lipid disorder (a ratio of total cholesterol level to the level of high density lipoprotein cholesterol>5 or use of lipid-lowering drugs), hypertension (systolic blood pressure> or =140 mmHg or diastolic blood pressure> or =90 mmHg or use of anti-hypertensive medications), and diabetes mellitus (fasting serum plasma glucose level> or =126 mg/dl or use of anti-diabetic medications) were determined. RESULTS: In comparison to women, men had a higher prevalence of current smoking (42.1 vs 5.6%), overweight (25.1 vs 17.1%) and obesity (33.1 vs 21.5%), lipid disorder (45.1 vs 19.6%), hypertension (17.4 vs 13.2%), as well as diabetes mellitus (4.1 vs 3.4%). The prevalence of men or women having two or more of the cardiovascular risk factors of interest was 54.3 and 21.7%, respectively. With advancing age, the prevalence of risk factors became greater for both genders. More importantly, the clustering of risk factors increased monotonically with increasing BMI levels for men and women. CONCLUSIONS: The prevalence and clustering of cardiovascular risk factors are commonplace in this healthy Chinese adult population. Considering the significant association between clustering of risk factors under study and BMI levels, this study gives an indication that population-based multifactorial interventions may work out favorably for specific groups.     

Blood pressure, smoking and body mass in relation to mortality from stroke and coronary heart disease in the elderly. A 10-year follow-up in Norway.

OBJECTIVES: To examine the association between blood pressure, smoking and body mass index (BMI) and cerebro- and cardiovascular mortality in a population of healthy elderly. DESIGN: Ten-year mortality follow-up of elderly men and women who participated in the Nord-Tr?ndelag Health Study 1984-86. SETTING: Nord-Tr?ndelag county, Norway. SUBJECTS: 3121 men and 3271 women aged 70 years and older, free from any diagnosed atherosclerotic diseases or diabetes at baseline. MAIN OUTCOME MEASURES: Relative risk of cerebro- and cardiovascular mortality and all-cause mortality according to blood pressure, smoking and BMI. RESULTS: There was a consistent, positive association between systolic and diastolic blood pressure and cerebro- and cardiovascular mortality. The association persisted after adjustment for potential confounding factors, and was strongest for cerebrovascular mortality; the adjusted relative risks for systolic blood pressure categories 160-179 mmHg and > or = 180 mmHg in men were 1.63 (95% confidence interval, CI 1.06-2.53) and 2.19 (95% CI 1.39-3.44) compared to blood pressure < 140 mmHg. In women, the corresponding relative risks were 1.54 (95% CI 0.93-2.56) and 2.12 (95% CI 1.29-3.50). For diastolic blood pressure the adjusted relative risks in categories 100-109 and > or = 110 mmHg in men were 1.88 (95% CI 1.19-2.95) and 3.06 (95% CI 1.79-5.21) compared to pressure <90 mmHg. The corresponding relative risks in women were 1.75 (95% CI 1.05-2.91) and 2.02 (95% CI 1.04-3.93). Current smoking increased cardiovascular mortality in both men and women, and among women, BMI was negatively associated with all-cause mortality. CONCLUSIONS: These findings add to the growing evidence that hypertension is a major risk factor for mortality from stroke and coronary heart disease among the elderly and the very old.     

Influence of height,leg and trunk length on pulse pressure,systolic and diastolic blood pressure

OBJECTIVE: To compare the effects of height, leg and trunk length on pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP) in men and women. DESIGN: Prospective, population-based, birth cohort study. SETTING: England, Scotland and Wales. PARTICIPANTS: A total of 1472 men and 1563 women aged 53 years and followed since their birth in 1946. MAIN OUTCOME MEASURES: PP, SBP and DBP at age 53 years. RESULTS: PP increased linearly with decreasing height and leg length in men and women [shortest compared with the tallest height (leg length) group, men 54.6 versus 51.0 mmHg (55.8 versus 50.7 mmHg), women 52.9 versus 48.4 mmHg (53.3 versus 48.6 mmHg); P for trend < or = 0.001 in each case]. Adjustment for adult confounding factors and childhood social class or birth weight only slightly weakened these results (P for trend < or = 0.01 in each case). SBP, but not DBP, showed similar but weaker trends in men and women, except for the association with height in men, which lost statistical significance after adjustment. Trunk length was not associated with any outcome measure in men or women. CONCLUSIONS: Short height and leg length are associated with increased PP and SBP, but not DBP, in middle-aged men and women. PP is a potential mediator between short height and leg length and increased risk of coronary heart disease. Future studies of the association between shortness and coronary heart disease should consider the role of arterial hemodynamics.     

High heart rate: a risk factor for cardiovascular death in elderly men

OBJECTIVE: To examine the association between heart rate and 12-year incidence rates of total and cardiovascular death in a cohort of elderly subjects stratified by sex. SUBJECTS AND METHODS: The study was carried out in 763 white men and 1175 women aged 65 years or older who were participating in the Cardiovascular Study in the Elderly. Subjects were divided into quintiles of heart rate; the top quintile comprised those with a heart rate of greater than 80/min and the bottom quintile, those with a heart rate of less than 64/min. RESULTS: In the men, the number of deaths from cardiovascular causes was significantly increased in those in the top quintile of heart rate (crude relative risk, 1.55) but decreased in those in the bottom quintile (crude relative risk, 0.65). Similar relationships were found in the women, but the associations did not reach statistical significance (all-cause, P = .11; cardiovascular, P = .15). After adjustment for baseline age, body mass index, hypertension, diabetes mellitus, angina or previous myocardial infarction (coronary heart disease), regular medication, lipid levels, smoking, alcohol intake, forced expiratory volume in 1 second, and other confounders, the relative risk for cardiovascular death in the men was 1.38 (95% confidence interval, 0.94-2.03) for the subjects in the top quintile of heart rate and 0.82 (95% confidence interval, 0.52-1.28) for those in the bottom quintile. In the Cox analysis, predictors of time to cardiovascular death were heart rate (P < .001), age (P < .001), coronary heart disease (P < .001), clinical heart failure (P = .001), diabetes mellitus (P = .001), hypertension (P = .02), and triglyceride levels (P = .04), whereas total (P = .20) and high-density lipoprotein-cholesterol (P = .21) levels and smoking (P = .74) were found to be nonsignificant by the model. The heart rate-cardiovascular death association held true when subjects who died in 2 years after enrollment were excluded (P = .008). CONCLUSIONS: An elevated heart rate may be a strong predictor of cardiovascular death in elderly men. Conversely, a low heart rate is related to a better outcome in these subjects.     

Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM.

AIMS: To investigate pulse pressure (PP) as an independent predictor of coronary heart disease (CHD) risk. METHODS AND RESULTS: On the basis of a 10-year follow-up of 5389 men aged 35-65 at recruitment into PROCAM, we used a proportional hazards model to calculate the effect of systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP on CHD risk after correcting for age, high-density lipoprotein cholesterol, LDL cholesterol, triglycerides, smoking, diabetes, and family history of premature CHD. Increases of 10 mmHg in DBP, SBP, and PP were associated with an increased CHD hazard ratio (HR) of approximately 10%. When the group was divided into the age groups <50, 50-59, and >59 years, this relationship was seen in the age group 50-59 years for DBP, SBP, and PP and in men aged > or =60 for PP only (25% increase in HR). Overall, CHD risk in men with PP > or =70 mmHg was more three times that of men with PP <50 mmHg. This increased risk was not apparent at age <50 years, was greatest at age >60 years, and was also present in men who were normotensive at recruitment (SBP < or =160 mmHg, DBP < or =95 mmHg). CONCLUSION: In older European men, increased PP is an important independent determinant of coronary risk, even among those initially considered normotensive.     

High heart rate relates to clustering of cardiovascular risk factors in a screened cohort.

Increased heart rate (HR) is a predictor of cardiovascular mortality, so the present study used a screened cohort to investigate whether the clustering of cardiovascular risk factors is associated with increased HR. Individuals who were receiving medication for hypertension or heart disease and those who did not have an ECG record or who had a record of arrhythmia were excluded. In total, 8,508 subjects (5,299 men, 3,209 women; age range, 18-89 years) were studied. Subjects were divided into 2 HR classes using the value of mean HR+ 1 SD as the cut-off point: low HR (HR < 77 beats/min, n=7,320) and high HR (HR > or = 77 beats/min, n=1,188). For logistic regression analysis, the dependent variable was HR class and the independent variables were the number of risk factors (ie, hypertension, diabetes mellitus, and hypertriglyceridemia each of which was associated positively with HR class by multivariate analysis). The odds ratios and 95% confidence intervals for the number of risk factors were 1.412 (1.216-1.640) for 1 risk factor, 2.800 (2.269-3.455) for 2, and 4.582 (2.815-7.459) for 3. Multivariate regression analyses showed that the number of risk factors from 0 to 3 correlated positively with high HR. HR increased significantly with clustering of risk factors even with low HR (regression coefficient was 1.147, p<0.0001). Modifying the risk factors may lower HR and reduce cardiovascular mortality.     

Association between pulse pressure, carotid intima-media thickness and carotid and/or iliofemoral plaque in hypertensive patients

Increased common carotid artery intima-media thickness (CCA-IMT) and carotid and/or iliofemoral (C/IF) plaque are frequent in subjects treated for hypertension, but their association with pulse pressure (PP) has rarely been studied. Using ultrasound techniques, CCA-IMT and C/IF plaques were studied in 323 hypertensive subjects, who were classified into four groups according to the adequacy of blood pressure (BP) control (systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg) and PP (high or low). After adjustment for confounding variables, an increase in CCA-IMT was the only factor significantly and independently associated with high PP, irrespective of the effectiveness of blood pressure control and of antihypertensive drug treatment. CCA-IMT correlated with age, PP, waist-to-hip ratio, tobacco consumption, and heart rate. C/IF plaques correlated with age, tobacco consumption, diabetes mellitus, and dyslipidaemia. To conclude, even with SBP<140 mmHg and DBP<90 mmHg on treatment, hypertensive subjects may have increased CCA-IMT values and C/IF plaque. Four cardiovascular risk factors seem to be involved in these alterations, namely tobacco consumption, dyslipidaemia, diabetes and increased PP. Only the latter factor does not have a standardized effective treatment.     

Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk

We assessed the morbidity and mortality of subjects with transiently elevated diastolic pressure in the General Practice Hypertension Study Group (GPHSG) population. A total of 23 578 patients (aged 18-65 years) from seven UK general practices were screened in 1974 for a diastolic blood pressure (DBP4) of > or = 90 mmHg. Two further readings of DBP4 determined hypertensive (either DBP4 > or = 90 mmHg) or transient hypertensive (both DBP4 < 90 mmHg) status. Transients (n = 850) were matched with normotensive controls (n = 824) and risk ratios calculated over a mean follow-up of 18.7 years. Rescreening was conducted in six of the practices (n = 20 942) after 7.7 years. Male transients had a higher relative hazard for cardiovascular mortality than controls (11.8%, 8.6%, adjusted relative hazard 1.59, P = 0.056). Female transients had a lower relative hazard for cardiovascular mortality than controls (3.6%, 5.4%, adjusted relative hazard 0.39, P = 0.018). In all, 422 patients with transient hypertension were rescreened along with 367 matched controls. Significantly more transients were on antihypertensive treatment compared with their controls (odds ratio (OR) [95% CI]) for both male (4.2 [1.6-11.1]) and female patients (2.4 [1.0-5.56]) and more untreated female transients developed hypertension. Male transients had a higher rates of diabetes mellitus (adj OR = 5.1, P = 0.04) and stroke (adj OR 15.9, P = 0.03). This study has shown that transiently elevated DBP in GPHSG is associated with a significantly higher risk of later hypertension in men and women and of diabetes, stroke and cardiovascular mortality in men. Women with this condition have a significantly lower cardiovascular mortality.     

Short duration of reactive hyperemia in the forearm of subjects with multiple cardiovascular risk factors.

BACKGROUND: Peripheral vascular endothelial dysfunction is an independent predictor of cardiovascular events, and can be assessed noninvasively by measuring reactive hyperemia, either by vascular ultrasound measurement of flow-mediated vasodilatation or, less commonly, by measurement of blood flow using plethysmography. In the present study reactive hyperemia was measured using plethysmography in healthy subjects with multiple cardiovascular risk factors. METHODS AND RESULTS: Reactive hyperemia was measured following 5-min occlusion of the upper arm in 449 healthy subjects (302 men, 147 women, age range 20-70 years) with (n=352) and without (n=97) risk factors such as smoking, hypertension, diabetes mellitus, hypercholesterolemia, obesity, family history of cardiovascular disease, and menopause. Maximum blood flow and minimum vascular resistance in reactive hyperemia did not differ between subjects with and without risk factors regardless of gender. Duration of reactive hyperemia, however, was significantly shorter in subjects with risk factors. Age-adjusted mean value of duration of reactive hyperemia was significantly smaller in men with a smoking habit, diabetes mellitus, hypercholesterolemia or obesity, and in women with smoking habit, hypertension, diabetes mellitus or obesity. The number of risk factors significantly correlated with the duration of reactive hyperemia in both men (r=-0.56, p<0.001) and women (r=-0.62, p<0.001), suggesting that endothelial dysfunction increases with the number of risk conditions clustering in a single individual. CONCLUSIONS: Duration of reactive hyperemia reflects cardiovascular risk factors and decreases with the number of risk conditions. These findings suggest that the duration of reactive hyperemia measured with plethysmography is potentially useful for assessing endothelial dysfunction.     

Relation of heart rate with cardiovascular disease in normal-weight individuals: the Chicago Heart Association Detection Project in Industry

The authors investigated the association of resting heart rate (RHR) with cardiovascular disease (CVD) risk factors and mortality among normal-weight individuals. Using data from our cohort (baseline examination in 1967-1973), individuals with a body mass index of 18.5 to 24.9 kg/m(2) (men [n=3724] and women [n=4929] aged 18-39; men [n=1959] and women [n=3735] aged 40-59), were grouped by RHR: <75, 75-84, and > or =85 beats per minute (bpm). A lower RHR was associated with lower mean blood pressure (BP) and cigarette use in each subgroup and total cholesterol (TC) and diabetes in men (P<.05). After a 32-year follow-up, hazard ratios (95% confidence intervals) for CVD mortality for an RHR <75 compared with > or =85 bpm adjusted for age, race, education level, BP, cigarette use, diabetes, and TC were 0.58 (0.34-0.84), 0.73(0.56-0.95), and 0.77 (0.61-0.98) for men aged 18 to 39 and men and women aged 40 to 59, respectively. In women aged 18 to 39, the relationship was not significant. In general, normal-weight individuals with lower RHRs have lower levels of CVD risk factors and mortality.     

Arterial pulse pressure in relation to the duration of type 1 diabetes: a cross-sectional controlled study

Diabetes mellitus and arterial pulse pressure (PP) are two independent cardiovascular risk factors. This cross-sectional study investigated the influence of diabetes duration on PP in type 1 diabetic patients without any cardiovascular disease. PP was measured continuously during 3 minutes (active orthostatic test: 1 min standing--1 min squatting--1 min standing) using a fingertip plethysmograph (Finapres) in 159 type 1 diabetic patients aged 20-60 yrs. They were divided into 4 groups according to diabetes duration: (1) G1 : <10 yrs (n=39); G2: 11-20 yrs (n=45); G3: 21-30 yrs (n=57); and G4: >30 yrs (n=18). In order to separate the effects of age from the effects of diabetes duration, diabetic patients were compared to age- and sex-matched non diabetic controls. PP (expressed in mmHg; mean +/- SD) was higher in men than in women in both diabetic (58 +/- 15 vs. 50 +/- 14; p = 0.001) and non diabetic subjects (55 +/- 14 vs. 47 +/- 12; p = 0.001). Overall PP was higher in diabetic than in non diabetic individuals (54 +/- 15 vs. 50 +/- 13; p = 0.025). PP progressively increased according to diabetes duration: 47 +/- 16 vs. 51 +/- 13 vs. 59 +/- 14 vs. 62 +/- 12, from G1 to G4 respectively; p < 0.0001. Such an increase was not observed in age-matched non diabetic subjects: 50 +/- 11 vs. 52 +/- 12 vs. 49 +/- 14 vs. 52 +/- 18, from G1 to G4, respectively; NS. PP was higher in squatting than in standing position in non diabetic subjects (52 +/- 16 vs. 47 +/- 13; p < 0.0001) and even more in diabetic patients (59 +/- 17 vs. 50 +/- 14; p < 0.0001). Overall, PP difference between diabetic and non diabetic individuals was not significant in standing position (50 +/- 14 vs. 47 +/- 13; NS) although it became highly significant in squatting position (59 +/- 17 vs. 52 +/- 16; p = 0.0005). The squatting-standing difference in PP markedly increased with diabetes duration: 69 +/- 14 during squatting vs. 50 +/- 18 during standing in G4 compared to respectively 50 +/- 17 vs. 44 +/- 15 in G1 diabetic patients. Finally, PP was similar (NS) in diabetic patients with HbA1c < 8% (54 +/- 14) or > or =8% (55 +/- 16), with (57 +/- 17) or without (54 +/- 14) microalbuminuria, treated (56 +/- 14) or not (54 +/- 15) by inhibitors of the renin-angiotensin system. In conclusion, PP progressively increased with the duration of type 1 diabetes, independently of age. Such increase was more marked in squatting than in standing position. The role of such PP rise in the increased cardiovascular risk of patients with type 1 diabetes, although suspected in the recent EURODIAB Prospective Complications Study, deserves further investigation.     

Heightened acute circulatory responses to smoking in women

Objective. Smoking, a major risk factor for cardiovascular morbidity and mortality, may be particularly harmful to women. Sympathetic and hemodynamic responses to cigarette smoking may be implicated in the link between smoking and acute cardiovascular events. We tested the hypothesis that acute effects of smoking on cardiovascular function are potentiated in women compared with men. Methods. We examined the effects of cigarette smoking and sham smoking on muscle sympathetic nerve activity, blood pressure and heart rate in 20 female and 20 male middle-aged healthy habitual smokers. Results. Sham smoking had no effect on muscle sympathetic nerve activity, blood pressure, or heart rate. Although cigarette smoking increased average systolic blood pressure and heart rate in both females and males, systolic blood pressure increased more in women (12+/-2 mmHg) than in men (6+/-2 mmHg; p = 0.02), as did heart rate (16+/-2 beats/min in women vs 9+/-2 beats/min in men; p = 0.002). Female smokers also had greater smoking-related increases in systolic blood pressure variability compared with males (2.2+/-0.6 vs 0.4+/-0.4 mmHg, respectively; p = 0.01) and greater decreases in RR variability (-28+/-5 vs -7+/-4 ms; p = 0.002). Despite the potentiated blood pressure increase in females, which would be expected to inhibit sympathetic activity to a greater extent in females than in males, changes in muscle sympathetic nerve activity during smoking were similar in both sexes. Conclusions. Acute pressor and tachycardic effects of smoking are potentiated in women compared with men. These findings may have important implications for understanding increased vulnerability to acute cardiovascular events in women who smoke.     

Determinants and prognostic information provided by pulse pressure in patients with coronary artery disease undergoing revascularization. The Balloon Angioplasty Revascularization Investigation (BARI)

Arterial stiffness, as evidenced by increased pulse pressure (PP), is associated with adverse cardiovascular events. However, the prognostic importance of PP in patients who have undergone revascularization is unknown. We examined the prognostic importance of PP and predictors of increased PP in patients entered into the Balloon Angioplasty Revascularization Investigation (BARI). Estimated correlation and standardized regression coefficients were reported, indicating the relative magnitude of independent effects of baseline characteristics on PP. The independent association of PP and outcome over 5 years was determined. Baseline characteristics independently associated with PP were higher mean arterial pressure, older age, female sex, noncoronary vascular disease, history of diabetes mellitus, and history of hypertension (p <0.001 for all). Cox regression covariates significantly associated with time to death were age, smoking, male gender, diabetes history, congestive heart failure, and baseline use of angiotensin-converting enzyme inhibitors, diuretic, or digitalis. When PP was added to the model, it was found to be an independent predictor of time to death (p = 0.008). When PP and mean arterial pressure were added to the model, PP remained significantly associated with time to death (p = 0.033). When renal disease and noncoronary vascular disease were added to the model, the relative risk declined from 1.07 to 1.04 and the association was no longer statistically significant. Thus, increased PP is directly and independently associated with mean arterial pressure, hypertension, age > or =65 years, diabetes mellitus, and the presence of noncoronary vascular disease, and inversely associated with a history of myocardial infarction. After coronary revascularization, PP, reflecting arterial stiffness, is independently associated with total mortality.     

Hyperuricemia as a predictor of hypertension in a screened cohort in Okinawa, Japan.

Several epidemiological studies have shown a positive association between serum uric acid levels and the risk of hypertension. However, subjects in these studies were mostly men, or were incompletely examined for lifestyle-related variables. We prospectively examined the relation between hyperuricemia and the risk of developing hypertension with consideration for alcohol consumption and smoking habits in a large screened cohort of men and women. A total of 4,489 individuals (2,927 men and 1,562 women) who did not have hypertension and were not currently using antihypertensive medication were examined at the Okinawa General Health Maintenance Association in 1977. Subjects were re-examined in 2000. Hyperuricemia was defined as a serum uric acid level >or=7.0 mg/dl in men and >or=6.0 mg/dl in women. Hypertension was defined as systolic blood pressure (SBP) >or=140 mmHg, and/or diastolic blood pressure (DBP) >or=90 mmHg. A total of 289 subjects (201 men and 88 women) were hypertensive (SBP >or=140 mmHg, and/or DBP >or=90 mmHg) in 2000. Multivariate analysis was performed for development of hypertension in hyperuricemic subjects, adjusted for age, family history of hypertension, alcohol consumption, cigarette smoking, obesity, hypercholesterolemia, hypertriglyceridemia, low high-density lipoprotein cholesterol, and diabetes mellitus. The adjusted odds ratio (95% confidence interval) in men was 1.48 (1.08-2.02) and in women was 1.90 (1.03-3.51) (p <0.05, respectively). The results showed hyperuricemia to be a new predictor of hypertension development in both men and women.     

Association between serum uric acid levels and cardiovascular events in hospitalized patients with type 2 diabetes

AimsThis study aimed to determine the association between serum uric acid (UA) levels and cardiovascular events in hospitalized patients with type 2 diabetes mellitus (T2DM).MethodsA retrospective cohort study was conducted in 2227 hospitalized patients with T2DM. Cox proportional hazards regression was used to assess the association between serum UA and cardiovascular events, including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, heart failure, unstable angina, and arrhythmias requiring hospitalization.ResultsAmong 1314 men, 143 (10.9%) experienced cardiovascular events. Serum UA level was not associated with the risk of cardiovascular events (hazard ratio [HR] per 100 μmol/L increase in serum UA: 1.12, 95% confidence interval [CI]: 0.90–1.40). Among 913 women, 96 (10.5%) experienced cardiovascular events. For every 100 μmol/L increase in serum UA level, the risk of experiencing a cardiovascular event increased by 27% (HR: 1.27, 95% CI: 1.02–1.57).ConclusionsIn hospitalized patients with T2DM, baseline serum UA levels were positively associated with cardiovascular events in women, but not in men. Serum UA levels may be a significant independent risk factor for cardiovascular events in women with T2DM.     

75岁以上老年女性冠心病患者的临床特点分析

目的分析不同性别的老年冠心病临床特征,探讨影响老年女性冠心病的危险因素。方法选择年龄75岁的冠心病患者156例,男性94例,女性62例,比较两者既往病史、生化指标、干预方法等的差异,分析影响预后的危险因素。结果女性患者中,糖尿病、骨折史、脑卒中发病率分别为74.19%、1 6.21%、38.71%,男性分别为38.30%、2.13%、25.53%,差异有统计学意义(P0.05);女性患者TG水平较男性高(P0.01)、再血管化治疗率较男性低(P0.05)。logistic回归分析显示,肾小球滤过率(OR=0.967,P0.01)是影响女性患者预后的独立危险因素。结论年龄75岁女性冠心病患者的特点是糖尿病、骨折史、高甘油三酯血症、再血管化治疗率低,低肾小球滤过率是影响女性患者预后的独立危险因素。     

Systolic,diastolic, and pulse pressures as coronary risk factors in a population with low cholesterol levels: a prospective 10-year evaluation

BACKGROUND: Pulse pressure (PP) has recently been found to be predictive of subsequent cardiovascular, particularly coronary, events in some middle-aged and elderly populations. HYPOTHESIS: The aim of this prospective population-based study was to evaluate the roles of systolic (SBP), diastolic blood pressure (DBP), and PP in predicting coronary heart disease (CHD) morbidity and mortality in both genders in a population of a wide age span and a setting of low levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol. METHODS: Of participants in the Turkish Adult Risk Factor Study aged > or = 20 years, those free of CHD at baseline examination in 1990 were followed up for a mean of 9.3 years. Coronary heart disease was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms (ECGs). In 2,601 men and women (mean age at baseline 41.4 +/- 15 years), deaths from CHD developed in 80 and nonfatal CHD in 158 patients. RESULTS: In a logistic regression analysis for predictors of composite endpoint of coronary mortality and morbidity, individually. DBP was not significantly and independently associated, while SBP was an independent risk predictor in both genders (relative risk [RR] 1.016). When two of three blood pressure components were entered jointly into the multivariable model, PP had a value inferior to that of SBP among men and women, but was of greater value than DBP in men in predicting both the composite endpoint and death from CHD. Among women, the predictive values of PP and DBP were similar. Within the categories of SBP > or = 120 mmHg in men, PP contributed significantly to the predictive power of SBP in overall CHD risk over and above that supplied by SBP, whereas DBP remained noncontributory. CONCLUSION: Although inferior to the predictive power of SBP, PP was an important determinant of CHD risk in a population of a diverse age span and a better predictor than DBP in men.     

Pulse pressure and systolic night-day ratio interact in prediction of macrovascular disease in patients with type 2 diabetes mellitus

Patients with type 2 diabetes mellitus are at increased risk of cardiovascular disease (CVD). We examined the predictive ability of 24-hour ambulatory pulse pressure (24-h PP), ambulatory arterial stiffness index (AASI) and diurnal blood pressure (BP) parameters for fatal and non-fatal CVD in patients with type 2 diabetes mellitus. A total of 108 patients with type 2 diabetes mellitus (mean duration 6.6 years) were followed for 9.5 (0.5-14.5) years. At baseline, all patients underwent ambulatory BP monitoring. During follow-up, 45 patients had cardiovascular (CV) events (35 non-fatal and 10 fatal). In bivariate analysis, events during follow-up were predicted by 24-h PP (P<0.01), AASI, 24-h systolic BP and systolic and diastolic night-day BP ratio (P<0.05 for all). In Cox regression analysis adjusted for established risk markers, only 24-h PP and systolic night-day BP ratio predicted CV events, P<0.05 for both. A significant interaction between the two parameters was found, P<0.05; thus, the higher the systolic night-day ratio, the greater the increase in hazard ratio (HR) per mmHg increase in 24-h PP and vice versa. A combined 10?mmHg increase in 24-h PP and 10%-point increase in systolic night-day ratio from the 25th percentile increased the adjusted HR (95% confidence interval) for CV events with 1.29 (0.53; 3.12), whereas a similar increase from the 75th percentile increased the HR with 4.2 (1.54; 11,51). Our study showed that 24-h PP and systolic night-day ratio interact as predictors of CV events in type 2 diabetes patients, and should be considered in conjunction when evaluating the risk of CVD.     

Increased plasma basic fibroblast growth factor is associated with coronary heart disease in adult type 2 diabetes mellitus

Basic fibroblast growth factor (bFGF) is a potent endothelial and smooth muscle cell mitogen that does not normally circulate. Plasma bFGF-like bioactivity was increased in association with persistent microalbuminuria (a risk marker for cardiovascular disease) in adult type 2 diabetes mellitus. In the present study, we tested whether baseline plasma bFGF immunoreactivity (IR) predicts the occurrence of a subset of cardiovascular disease outcomes in adults with advanced type 2 diabetes mellitus from the Veterans Affairs Diabetes Trial (mean: age, 59 years; diabetes duration, 11 years; baseline hemoglobin A_1c, 9.5%). Plasma bFGF-IR was determined with a sensitive and specific 2-site enzyme-linked immunoassay in 399 patients at the baseline visit. These results were then evaluated as possible predictors of the occurrence of prespecified cardiovascular or coronary heart disease end points. There was a borderline-significant association (P = .07) between plasma bFGF-IR and the main study cardiovascular disease outcome (myocardial infarction, congestive heart failure, cerebrovascular accident, amputation, cardiovascular death, coronary, cerebrovascular or peripheral revascularization, and inoperable coronary artery disease). Plasma bFGF-IR was significantly associated with the occurrence of coronary heart disease (P = .01). After adjusting for clinical risk factors, bFGF (hazard ratio [HR], 1.013; 95% confidence interval [CI], 1.007-1.019; P < .0001), prior macrovascular event (HR, 3.55; 95% CI, 2.154-5.839; P < .0001), and duration of diabetes (HR, 1.041; 95% CI, 1.012-1.071; P = .0055) were all significantly associated with time to first postrandomization coronary heart disease occurrence. These results suggest that increased plasma bFGF-IR may be a novel risk marker for coronary heart disease occurrence in adult men with advanced type 2 diabetes mellitus.