| Title: | Pulse pressure and cardiometabolic disease progression: associations with incident multimorbidity and mortality in UK biobank |
| Journal: | Frontiers in Cardiovascular Medicine |
| Published: | 23 Jun 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/42428475/ |
| DOI: | https://doi.org/10.3389/fcvm.2026.1829003 |
| URL: | https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2026.1829003/pdf |
Publication 20567
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Abstract
Background: Although pulse pressure (PP) predicts individual cardiometabolic diseases (CMDs), its role in the progression of cardiometabolic multimorbidity (CMM) remains uncertain. This study aimed to investigate the association between PP and CMD progression, from incident CMD to CMM development and all-cause mortality.</p>
Methods: UK Biobank participants (N = 403,851) were prospectively assessed. PP was evaluated per 1-standard-deviation (SD) increase and across quartiles (Q1-Q4) using Cox proportional hazards models for associations with: (1) incident CMD, (2) progression to CMM (defined as two or more of type 2 diabetes, coronary heart disease, or stroke), and (3) all-cause mortality. Restricted cubic splines were used to examine nonlinearity, and threshold effects were identified using piecewise regression. Competing-risk analyses (Fine-Gray models) and sensitivity analyses excluding the first 2 years of follow-up were performed to address mortality-related competing events and potential reverse causality, respectively. Subgroup analyses were stratified by age, sex, and body mass index (BMI).</p>
Results: Among 403,851 UK Biobank participants who were free of CMD at baseline, per 1-SD increase in PP was significantly associated with transitions from health to CMD (HR = 1.13, 95% CI: 1.12-1.14) and to CMM (HR = 1.18, 95% CI: 1.15-1.21), with Q4 versus Q1 comparisons indicating 36% higher risks for both outcomes. Notably, the PP-CMM association was strongest among patients with stroke, with an HR of 1.23 (95% CI: 1.11-1.36) per 1-SD increase. Subgroup analyses further showed that this association was most pronounced in participants aged < 60 years, women, and those with BMI 18.5 ≤ 25 kg/m2. Threshold-effect analyses identified specific risk turning points: 40 mmHg for incident CMD, 42 mmHg for mortality, and 52 mmHg for CMM development among healthy participants, and 57 mmHg for mortality among participants with established CMM.</p>
Conclusion: Our study demonstrates that elevated PP is significantly associated with higher risks of CMD progression and mortality.</p>
7 Authors
- Ting Lin
- Shuai Hu
- Wen Gong
- Linqi Li
- Zhaowei Zhu
- Hebin Xie
- Feijun Zhao
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