Association of pulse pressure with death, myocardial infarction, and stroke among cardiovascular outcome trial participants
Background: Prior evidence demonstrates that pulse pressure (PP), a surrogate marker of arterial stiffness, is an independent risk factor for mortality and major adverse cardiovascular (CV) events. Objectives: The study aimed to identify the association of PP with death, myocardial infarction, and s...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | American Journal of Preventive Cardiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667723001642 |
| _version_ | 1797237921673117696 |
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| author | Neel Agarwal Julie St. John Erik H. Van Iterson Luke J. Laffin |
| author_facet | Neel Agarwal Julie St. John Erik H. Van Iterson Luke J. Laffin |
| author_sort | Neel Agarwal |
| collection | DOAJ |
| description | Background: Prior evidence demonstrates that pulse pressure (PP), a surrogate marker of arterial stiffness, is an independent risk factor for mortality and major adverse cardiovascular (CV) events. Objectives: The study aimed to identify the association of PP with death, myocardial infarction, and stroke among participants enrolled in large CV outcome clinical trials and determine if this association was impacted by pre-existing CV disease, or specific CV risk factors. Methods: A total of 65,382 individuals, ages 19 to 98 years, that were enrolled in one of five CV outcome trials were analyzed. Baseline demographics, history, blood pressures, and medications were collected. Univariate and multivariable analyses were conducted to explore temporal patterns, risks, and adjusted survival rates. Results: Mean baseline PP was 52 ± 12 mmHg. For every 10 mmHg increase in PP, there was an increased risk of death, stroke, or myocardial infarction (hazard ratio (HR) 1.11, 95 % CI 1.08 to 1.14, p < 0.001). Similarly, a PP ≥ 60 mmHg demonstrated an HR of 1.27 (95 % CI 1.19 to 1.36, p < 0.001) compared with PP < 60 mmHg. A similar association existed for all subgroups analyzed except for participants with a history of stroke where increasing PP did not increase risk (HR 1.02, 95 % CI 0.95 to 1.10, p = 0.53). PP was a better predictor of adverse outcomes when compared to both systolic and diastolic blood pressures using the AIC and C-index. Conclusions: Among participants enrolled in CV outcome trials, baseline PP is associated with increased risk of death, myocardial infarction, and stroke for those with pre-existing CV disease and risk factors with the exception of a prior history of stroke. |
| first_indexed | 2024-03-09T02:41:45Z |
| format | Article |
| id | doaj.art-d81b3068a1bf42a996713c4402ca9292 |
| institution | Directory Open Access Journal |
| issn | 2666-6677 |
| language | English |
| last_indexed | 2024-04-24T17:27:26Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj.art-d81b3068a1bf42a996713c4402ca92922024-03-28T06:39:05ZengElsevierAmerican Journal of Preventive Cardiology2666-66772024-03-0117100623Association of pulse pressure with death, myocardial infarction, and stroke among cardiovascular outcome trial participantsNeel Agarwal0Julie St. John1Erik H. Van Iterson2Luke J. Laffin3Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United StatesCleveland Clinic, C5Research, 9500 Euclid Avenue, Cleveland, OH 44195, United StatesCleveland Clinic, Section of Preventive Cardiology and Rehabilitation, 9500 Euclid Avenue, Cleveland, OH 44195, United StatesCleveland Clinic, C5Research, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Cleveland Clinic, Section of Preventive Cardiology and Rehabilitation, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Corresponding author at: Section of Preventive Cardiology and Rehabilitation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code JB1, Cleveland, OH 44195, United States.Background: Prior evidence demonstrates that pulse pressure (PP), a surrogate marker of arterial stiffness, is an independent risk factor for mortality and major adverse cardiovascular (CV) events. Objectives: The study aimed to identify the association of PP with death, myocardial infarction, and stroke among participants enrolled in large CV outcome clinical trials and determine if this association was impacted by pre-existing CV disease, or specific CV risk factors. Methods: A total of 65,382 individuals, ages 19 to 98 years, that were enrolled in one of five CV outcome trials were analyzed. Baseline demographics, history, blood pressures, and medications were collected. Univariate and multivariable analyses were conducted to explore temporal patterns, risks, and adjusted survival rates. Results: Mean baseline PP was 52 ± 12 mmHg. For every 10 mmHg increase in PP, there was an increased risk of death, stroke, or myocardial infarction (hazard ratio (HR) 1.11, 95 % CI 1.08 to 1.14, p < 0.001). Similarly, a PP ≥ 60 mmHg demonstrated an HR of 1.27 (95 % CI 1.19 to 1.36, p < 0.001) compared with PP < 60 mmHg. A similar association existed for all subgroups analyzed except for participants with a history of stroke where increasing PP did not increase risk (HR 1.02, 95 % CI 0.95 to 1.10, p = 0.53). PP was a better predictor of adverse outcomes when compared to both systolic and diastolic blood pressures using the AIC and C-index. Conclusions: Among participants enrolled in CV outcome trials, baseline PP is associated with increased risk of death, myocardial infarction, and stroke for those with pre-existing CV disease and risk factors with the exception of a prior history of stroke.http://www.sciencedirect.com/science/article/pii/S2666667723001642Pulse pressureHypertensionCardiovascular outcomesClinical trial |
| spellingShingle | Neel Agarwal Julie St. John Erik H. Van Iterson Luke J. Laffin Association of pulse pressure with death, myocardial infarction, and stroke among cardiovascular outcome trial participants American Journal of Preventive Cardiology Pulse pressure Hypertension Cardiovascular outcomes Clinical trial |
| title | Association of pulse pressure with death, myocardial infarction, and stroke among cardiovascular outcome trial participants |
| title_full | Association of pulse pressure with death, myocardial infarction, and stroke among cardiovascular outcome trial participants |
| title_fullStr | Association of pulse pressure with death, myocardial infarction, and stroke among cardiovascular outcome trial participants |
| title_full_unstemmed | Association of pulse pressure with death, myocardial infarction, and stroke among cardiovascular outcome trial participants |
| title_short | Association of pulse pressure with death, myocardial infarction, and stroke among cardiovascular outcome trial participants |
| title_sort | association of pulse pressure with death myocardial infarction and stroke among cardiovascular outcome trial participants |
| topic | Pulse pressure Hypertension Cardiovascular outcomes Clinical trial |
| url | http://www.sciencedirect.com/science/article/pii/S2666667723001642 |
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