Pulse pressure is associated with age and cardiovascular disease in type 1 diabetes

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Abstract
Objective Type 1 diabetic individuals are thought to have increased arterial stiffness, and are at high risk for cardiovascular disease. However, it is not known whether increased arterial stiffness in type 1 diabetes causes cardiovascular disease. To explore this issue, the present study investigated the association, in type 1 diabetes, of age and pulse pressure, an estimate of arterial stiffness, and the influence of the presence of microvascular complications on this association. In addition, we determined the association of mean arterial pressure and pulse pressure with incident cardiovascular disease. Methods We studied a cohort of 3250 type 1 diabetic individuals of the EURODIAB Prospective Complications Study. Mean age and median follow-up were 33 and 7.4 years. One hundred and sixty-three individuals developed a first manifestation of cardiovascular disease during follow-up. Linear regression analysis was used to determine the association of age with pulse pressure. Relative risks of cardiovascular disease were estimated by Cox regression analyses adjusted for age, sex and mean arterial pressure or pulse pressure. Results In cross-sectional analyses, age was associated with pulse pressure (P< 0.001) and this association was stronger in the presence of micro- or macroalbuminuria or retinopathy than in their absence (interaction for albuminuria, P< 0.001; interaction for retinopathy, P< 0.001). In prospective analyses, both mean arterial pressure and pulse pressure were associated with cardiovascular disease [adjusted relative risks and (95% confidence interval) per 10 mmHg increase were 1.08 (0.94–1.24) and 1.09 (0.98–1.21)]. Conclusions This study shows an association of age with pulse pressure in young type 1 diabetic individuals, which is stronger in the presence of microvascular complications. In addition, both mean arterial pressure and pulse pressure are associated with incident cardiovascular disease. These findings support the concept of early vascular ageing in type 1 diabetes, especially in the presence of microvascular complications.