Abstract 3684: Pulse Pressure - A Readily Available Independent Predictor of Extent of Coronary Artery Atheroma on 64 Slice Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus
Background and aims: Identification of high risk sub-groups for early initiation of preventive medical therapy requires widespread population screening using simple, inexpensive tests. High pulse pressure (PP) has been shown to predict adverse coronary events. We examined the predictive value of PP for the presence of coronary plaque on 64 slice coronary CT angiography (CTA) in asymptomatic pts with type 2 diabetes mellitus (DM) and no history of CAD enrolled in an ongoing prospective outcomes study.
Methods: Resting systolic and diastolic blood pressure were measured in both arms, mean pulse pressure calculated and CTA performed in 186 pts (62.6±8.4 yrs, 60% women) with DM (mean duration 11.2±8.1 yrs) and no history of CAD.
Results: Risk factors included current or past smoking history in 42.5% and hypertension in 66.3%. Baseline therapy included insulin in 35%, ACE inhibitor or angiotensin receptor blocker in 65%, calcium channel blocker in 23%, beta blocker in 28% and statins in 71%. Prevalence of single vessel and multivessel plaque and of coronary stenosis in relaton to quartiles of pulse pressure are shown in table⇓. In a multivariate model including UKPDS score (age, gender, duration of diabetes mellitus, blood presssure, smoking history, cholesterol/HDL-C ratio and HBA1C) and ankle brachial ratio, pulse pressure was an independent correlate of the presence of multivessel coronary plaque (OR 1.29/10mmHg increase in PP, 95% CI 1.03 –1.56 , p=0.03).
Conclusions: In asymptomatic pts with DM and no history of CAD undergoing 64 slice CTA: 1. Pulse pressure predicted the presence and extent of coronary plaque. 2. This correlation was independent of ankle brachial ratio and of the UKPDS score. 3. Predictive value of pulse pressure should be further investigated as a readily available screening test for coronary disease in diabetic patients.