Stroke Volume/Pulse Pressure Ratio Linked to Insulin Resistance and Coronary Heart Disease Mortality

Stroke volume/pulse pressure (SV/PP) ratio is a non-invasive predictor of coronary heart disease (CHD) and serves as an indicator of the insulin resistance syndrome, which is characterised by obesity, hypertension, glucose intolerance, hyperinsulinaemia, and dyslipidaemia, according to researchers.

In order to investigate SV/PP (a measure of arterial compliance) as a cross-sectional indicator of the various components of the insulin resistance syndrome and as a longitudinal predictor of cardiovascular mortality, Lars Lind, MD, PhD, Department of Medical Sciences, Uppsala University Hospital, Sweden, and colleagues evaluated men at age 50 and again at age 70.

Between 1970-1973, all 50-year-old men in Uppsala County were invited to participate in the study. Of those invited, 2322 participated. Twenty years later, the first 583 consecutive subjects, out of the remaining 1221 participants, were re-evaluated with echocardiographic and Doppler examinations.

Of the originally enrolled subjects, 488 died between the ages of 50 and 70 (245 from cardiovascular disease and 175 from coronary heart disease). At age 50, 39% of the men were smokers; 3% received antihypertensive agents; and 0.4% were diabetic. At age 70, 20% were smokers; 35% received antihypertensive agents; and 14% were diabetic.

The patients were assessed with 2-dimensional echocardiography and left ventricular mass was calculated along with stroke volume. Insulin sensitivity was measured and an oral glucose tolerance test was administered. Fasting glucose, fatty acids, cholesterol, triglycerides, and HDL were measured and LDL was calculated.

After the men reached age 70, they were followed for a mean of 7.2 years (maximum 8.4 years). Seventy-two men died during the follow up; 33 from cardiovascular disease and 18 from coronary heart disease. Variation in the effect of SV/PP showed that several components of the insulin resistance syndrome, such as blood pressure, triglyceride levels, and glucose and insulin levels, were all inversely related to SV/PP. Furthermore, SV/PP predicted mortality from CHD (hazard ratio 0.54, 95% confidence interval 0.3 – 0.97) for a one standard deviation increase in SV/PP).

SV/PP was decreased in men with concentric left ventricular hypertrophy and was an independent predictor of CHD in this community based sample of elderly men.