Sex Difference in Cardiovascular Risk: Role of Pulse Pressure Amplification

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• 作者：V&eacute ; ronique Regnault ; PhD^鈦?/sup> ; ^&dagger ; ; Fr&eacute ; d&eacute ; rique Thomas ; PhD^&Dagger ; ; Michel E. Safar ; MD^§ ; ; Mary Osborne-Pellegrin ; PhD^鈭?/sup> ; ^¶ ; ; Raouf A. Khalil ; MD^# ; Bruno Pannier ; MD^&Dagger ; ; Patrick Lacolley ; MD^鈦?/sup> ; ^&dagger ; ; ^{Patrick.Lacolley@nancy.inserm.fr}
• 关键词：cardiovascular risk ; sex ; hypertension ; pulse pressure ; pulse pressure amplification
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 期刊代码：201_07351097
• 类别：med
• 出版时间：15 May, 2012
• 卷：59
• 期：20
• 页码：1771-1777
• 文件大小：477 K

摘要

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Objectives

The study was to explore whether the brachial/carotid pulse pressure (B/C-PP) ratio selectively predicts the sex difference in age-related cardiovascular (CV) death.

Background

Hypertension and CV complications are more severe in men and post-menopausal women than in pre-menopausal women. C-PP is lower than B-PP, and the B/C-PP ratio is a physiological marker of PP amplification between B and C arteries that tends toward 1.0 with age.

Methods

The study involved 72,437 men (ages 41.0 卤 11.1 years) and 52,714 women (39.5 卤 11.6 years). C-PP was calculated for each sex by a multiple regression analysis including B-PP, age, height and risk factors, and a method validated beforehand in a subgroup of 834 subjects. During the 12 years of follow-up, 3,028 men and 969 women died.

Results

In the total population, the adjusted hazard ratios (HR) (95%confidence interval [CI]) of B/C-PP ratio were: 1) for all-cause mortality: men, HR: 1.51 (95%CI: 1.47 to 1.56), women; HR: 2.46 (95%CI: 2.27 to 2.67) (p < 0.0001); and 2) for CV mortality: men, HR 1.81 (95%CI: 1.70 to 1.93); women, HR: 4.46 (95%CI: 3.66 to 5.45) (p < 0.0001). The B/C-PP impact on mortality did not significantly increase from younger men to those 鈮?5 years of age, from: HR: 1.44 (95%CI: 1.31 to 1.58) to HR 1.65 (95%CI: 1.48 to 1.84), but increased significantly with age in women: HR: 3.19 (95%CI: 2.08 to 4.89) versus HR: 5.60 (95%CI: 4.17 to 7.50) (p < 0.01). Thus, the mortality impact of B/C-PP ratio was 3-fold higher in women than in men 鈮?5 years old.

Conclusions

PP amplification is highly predictive of differences in CV risk between men and women. In post-menopausal women, the attenuation of PP amplification, mainly related to increased aortic stiffness, contributes to the significant increase in CV risk.