Limited data exist regarding the prevalence, extent and severity of coronary artery disease (CAD) as well as clinical outcomes in asymptomatic diabetic patients according to pulse pressure.Design and Method:
We enrolled 935 consecutive asymptomatic type 2 diabetic patients without known CAD. Coronary computed tomography angiography was used to evaluate the prevalence and severity of CAD. Brachial blood pressure was measured at baseline. Patients were assigned to quartile of pulse pressure (<40, 40–49, 50–59, and >=60 mmHg).Results:
The prevalence of obstructive CAD (≥50% stenosis) was increased from the lowest quartile of patients (26.5%) to the highest quartile of patients (54.5%) (p = <0.001). The incidence of obstructive CAD in multivessel or left main CAD also increased across the quartiles (11.7% to 32.0%, p < 0.001). Increase of pulse pressure by 10 mmHg was an independent predictor of obstructive CAD after adjusting for risk factors including systolic blood pressure (adjusted odds ratio, 1.293; 95% confidence interval (CI), 1.07–1.57, p = 0.008). During a median follow-up of 3.1 years, the highest quartile of pulse pressure was associated with increased risk of cardiac death or myocardial infarction compared to the risk in the lowest quartile (0% vs. 5.2%, log rank p = 0.019).Conclusions:
In asymptomatic type 2 diabetic patients, increased pulse pressure was associated with increased risk of CAD and poor clinical outcomes.