High pulse pressure is associated with an increased risk of diabetes in females but not in males: a retrospective cohort study

Abstract

Objective: Accumulating evidence suggests a close relationship between metabolic disturbance and increased arterial stiffness. However, whether there is an association between pulse pressure (PP) and diabetes and how this association might be impacted by sex is not clear.

Methods: A total of 209,635 adult Chinese individuals > 20 years old across 32 sites and 11 cities in China (Shanghai, Beijing, Nanjing, Suzhou, Shenzhen, Changzhou, Chengdu, Guangzhou, Hefei, Wuhan, Nantong) were included in the study; participants were free of diabetes at baseline. In the present study, we analyzed the relationship between PP at baseline and incident diabetes using the Cox proportional hazard model.

Results: During a median follow-up of 2.99 years, a total of 3971 participants (2885 men and 1086 women) developed diabetes, and the incidence was 6.3 per 1000 person-years. With each 10 mmHg increase in PP, the multivariable adjusted hazard ratio (HR) (95% confidence interval) for incident diabetes was 1.117 (1.061, 1.176) in females and 0.981 (0.951, 1.012) in males. Using the lowest quartile of PP as the reference category, the hazard ratio (HR) (95% CI) of the highest quartile of PP for incident diabetes was 1.494 (1.225, 1.822) in females and 0.939 (0.843, 1.045) in males. Smooth plots revealed a significant difference between males and females in the HRs for new-onset diabetes according to PP.

Conclusion: Higher PP was related to future diabetes development in females but not in males and further research is needed to explore the mechanism.

Keywords: Diabetes care; Pulse pressure; Sex differences.

Fig. 1

Flowchart of study participants

Fig. 2

Multivariate adjusted smooth curve fitting of log RR for incident diabetes and PP stratified by sex. The model was adjusted for age, BMI, smoking, alcohol consumption, family history of diabetes and FPG