THE INVERSE RELATIONSHIP OF PULSE PRESSURE TO LDL CHOLESTEROL IN PATIENTS WITH TYPE II DIABETES AND CKM (CARDIO KIDNEY METABOLIC) DISEASE

Objective: We investigated CKM parameters in patients with type II diabetes and found higher pulse pressure in those with advanced age, elevated glycosylated hemoglobin, kidney disease stages, albuminuria, and higher BMI. Notably, our study identified an inverse relationship between LDL and pulse pressure, a significant physiological finding given LDL’s importance as a CKM parameter in this population.Design and method: This cross-sectional study utilized data from the Diamond Database at the Imperial College Diabetes Centre, UAE’s largest type II diabetes treatment center. Patients over 18 years were included if they had annual urine ACR and GFR assessments per ADA guidelines. Blood pressure, blood, and urine tests from the latest patient visit were analyzed. Pulse pressure was calculated as systolic minus diastolic blood pressure (mmHg). Statistical analysis was performed using STATA MP version 17. Informed consent was obtained following the Declaration of Helsinki. Results: The study included 33,000 patients, with a mean age of 58.76 (±12.01) years and BMI of 29.41 (±4.41). Mean systolic and diastolic blood pressures were 125.00 (±15.23) mmHg and 73.18 (±8.79) mmHg, respectively, with a mean pulse pressure of 51.82 (±14.34). Mean eGFR, microalbumin, HbA1c, and LDL-C were 101.48 (±25.48), 23.05 (±40.77), 7.03 (±1.42), and 2.20 (±0.99), respectively. Pulse pressure positively correlated with age (r=0.412, p<0.001), BMI, microalbumin, and HbA1c, and negatively correlated with eGFR (r=-0.244) and LDL-C (r=-0.057). Conclusions: Elevated LDL appears to associate with reduced aortic stiffness, as demonstrated in studies of hypercholesterolemia and diabetes. This is the first real-world study to highlight the LDL-pulse pressure paradox in type II diabetes with CKM risk. The findings suggest other factors, such as homocysteine, may influence pulse pressure, warranting further research in this area.