Pulse pressure and coronary atherosclerosis in asymptomatic type 2 diabetes mellitus: a 64 channel cardiac computed tomography analysis.

BACKGROUND: Identification of high risk sub-groups for early initiation of preventive medical therapy requires widespread population screening using simple, inexpensive tests. High pulse pressure has been shown to predict adverse coronary events. We examined if this correlation was related to a greater coronary plaque burden in patients with high pulse pressure using 64 channel coronary computed tomographic angiography (CCTA) in patients with type 2 diabetes mellitus.

METHODS: The study included 427 consecutive asymptomatic diabetic patients with no history of coronary disease, (age 55-74 years, 58% women), undergoing CCTA as part of a prospective outcomes study.

RESULTS: Coronary atheroma was present in 76.6% of patients, multivessel coronary atheroma in 55.1% and luminal stenosis (>or=50% of diameter) in 22.9%. Pulse pressure (adjusted for age, gender, mean blood pressure and heart rate) correlated with number of coronary arteries with atheroma (p=0.005) and with multivessel coronary atheroma (odds ratio 1.24 95%CI 1.06-1.43 for each 10 mm Hg pulse pressure, p=0.009). The correlation was independent of Framingham and United Kingdom Prospective Diabetic Study risk scores (p=0.027 and p=0.036 respectively). Adjusted pulse pressure also correlated with quartiles of coronary artery calcium score (p=0.009).

CONCLUSION: Elevated pulse pressure was a useful independent marker of presence and extent of pre-clinical coronary artery disease in an asymptomatic diabetic population.