The stroke volume/pulse pressure ratio predicts coronary heart disease mortality in a population of elderly men

BACKGROUND: The stroke volume to pulse pressure ratio (SV/PP), a measure of total arterial compliance, predicts adverse cardiovascular events in hypertensive subjects. The relations to cardiovascular risk factors and its predictive capacity in the general population are not known. METHOD AND RESULTS: In 1970-73, all 50-year-old men living in Uppsala County, Sweden, were invited to a health survey assessing cardiovascular risk factors. At a reinvestigation 20 years later, 470 subjects underwent an echocardiographic examination, hyperinsulinaemic euglycaemic clamp, oral glucose tolerance test and measurements of blood pressure and lipids. They were thereafter followed for a median of 7.2 years. Serum triglycerides and post-load glucose and insulin levels at age 50 were predictors of SV/PP ratio measured 20 years later (P < 0.05-0.001). At age 70, SV/PP was related to serum non-esterified fatty acids, post-load glucose and insulin levels and insulin sensitivity (P < 0.05-0.001). SV/PP was reduced in subjects with concentric left ventricular hypertrophy (LVH, P < 0.01), and in subjects with a low E-wave to A-wave (E/A) ratio (P < 0.001). The SV/PP ratio predicted mortality from coronary heart disease [hazard ratio 0.54, 95% confidence interval 0.30-0.97 for a one standard deviation (1SD) increase in ln(SV/PP)] independently of left ventricular mass and other major cardiovascular risk factors. Pulse pressure or total peripheral resistance were not significant predictors for future mortality from coronary heart disease. CONCLUSION: The SV/PP ratio was related to main components of the insulin resistance syndrome, concentric LVH and a low E/A ratio. Furthermore, the SV/PP ratio was an independent predictor of mortality from coronary heart disease in a community-based sample of men aged 70.