Brachial artery pulse pressure and common carotid artery diameter: mutually independent associations with mortality in subjects with a recent historyof impaired glucose tolerance

Background Decreased large artery function, as reflected by increased brach ial artery pulse pressure and increased carotid artery diameter and stiffne ss, may contribute to the increased mortality risk that is observed in subj ects with impaired glucose tolerance. We therefore investigated the associa tion between brachial artery pulse pressure and carotid artery diameter and stiffness, which are estimates of central artery stiffness and arterial re modelling, respectively, and mortality in subjects with a recent history of impaired glucose tolerance. Design A prospective, population-based cohort study. We measured brachial a rtery pulse pressure by oscillometric blood pressure measurements, and comm on carotid artery diameter and distensibility and compliance coefficients b y ultrasound in 140 subjects with a recent history of impaired glucose tole rance. During a median 6.6-year follow-up, 16 subjects died. Results Brachial artery pulse pressure and common carotid artery diameter w ere positively related to all-cause mortality [hazard ratios per standard d eviation, 1.7 (1.2-2.5) and 2.1 (1.3-3.3), respectively], Results were simi lar after adjustment for gender, age, waist-to-hip ratio, body mass index, total cholesterol concentration, pre-existent cardiovascular disease, and h ypertension, I and after additional mutual adjustment. Common carotid arter y distensibility and compliance coefficients were not statistically signifi cantly associated with mortality. Conclusions Among subjects with a recent history of impaired glucose tolera nce, brachial artery pulse pressure and common carotid artery diameter are independently associated with mortality risk. Stiffness of the central arte ries may explain the association between pulse pressure and mortality risk. The association between carotid diameter and mortality risk is more likely to reflect arterial remodelling in response to atherosclerosis than that i n response to increased local stiffness.