BMI-residualized data uncovers a cluster of people with type 2 diabetes and increased serum ferritin protected from cardiovascular disease.

IF 8.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Diabetology Pub Date : 2025-03-26 DOI:10.1186/s12933-025-02685-w

Laura Gallardo-Nuell, Jordi Blanch, Yenny Leal, Daniel E Coral, Talita Duarte-Salles, Giuseppe N Giordano, Paul W Franks, Ewan R Pearson, Geltrude Mingrone, Carel W le Roux, Rafael Ramos, José Manuel Fernández-Real

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引用次数: 0

Abstract

Background: Understanding the relationship between serum ferritin levels and cardiovascular outcomes in type 2 diabetes is crucial for improving risk stratification and guiding therapeutic interventions aimed at preventing major adverse cardiovascular events (MACE). This study aimed to identify distinct clusters of individuals with type 2 diabetes who have varying risks of MACE using a data-driven clustering approach.

Methods: This retrospective cohort study analyzed data from 49,506 individuals within a multicenter, population-based primary care registry in Catalonia, Spain. Individuals diagnosed with type 2 diabetes at age 35 or older were recruited between January 2010 and December 2021 and followed for at least 10 years. Biomarkers associated with cardiovascular risk-including serum glucose, HbA1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, serum ferritin, leukocyte, and monocyte counts-were examined. Clustering analysis was applied to identify patient subgroups, and Cox proportional hazards models were used to assess associations with cerebrovascular events, coronary events, and composite MACE.

Results: Five distinct clusters were identified, characterized by differences in serum glucose, HbA1c, lipid profiles, blood pressure, and serum ferritin levels. Individuals with discordantly high serum ferritin levels relative to their body mass index (BMI) exhibited a lower risk of adverse cardiovascular outcomes. In men, hazard ratios (HR) were 0.68 (95% confidence interval [CI]: 0.53-0.87) for cerebrovascular events, 0.65 (95% CI 0.49-0.88) for coronary events, and 0.68 (95% CI 0.56-0.83) for MACE. In women, HRs were 0.81 (95% CI 0.67-0.92) for cerebrovascular events, 0.73 (95% CI 0.57-0.95) for coronary events, and 0.79 (95% CI 0.67-0.92) for MACE.

Conclusions: Individuals with type 2 diabetes who exhibit higher-than-expected serum ferritin levels relative to their BMI may have a lower risk of cardiovascular events. These findings suggest that ferritin may play a more complex role in cardiovascular risk than previously assumed and highlight the potential for refined risk stratification strategies in type 2 diabetes management.

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bmi残差数据揭示了一组2型糖尿病患者，血清铁蛋白升高可预防心血管疾病。

背景：了解血清铁蛋白水平与2型糖尿病心血管结局之间的关系，对于改善风险分层和指导旨在预防主要不良心血管事件（MACE）的治疗干预至关重要。本研究旨在使用数据驱动的聚类方法确定具有不同MACE风险的2型糖尿病个体的不同聚类。方法：这项回顾性队列研究分析了来自西班牙加泰罗尼亚多中心、以人群为基础的初级保健登记处的49,506名个体的数据。研究人员在2010年1月至2021年12月期间招募了年龄在35岁或以上的2型糖尿病患者，并对他们进行了至少10年的随访。检测与心血管风险相关的生物标志物，包括血清葡萄糖、糖化血红蛋白、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、血压、血清铁蛋白、白细胞和单核细胞计数。聚类分析用于确定患者亚组，Cox比例风险模型用于评估脑血管事件、冠状动脉事件和复合MACE的相关性。结果：确定了五个不同的集群，其特征是血清葡萄糖、糖化血红蛋白、血脂、血压和血清铁蛋白水平的差异。血清铁蛋白水平相对于其身体质量指数（BMI）不一致的个体表现出较低的不良心血管结局风险。在男性中，脑血管事件的危险比（HR）为0.68(95%可信区间[CI]: 0.53-0.87)，冠状动脉事件的危险比（HR）为0.65 (95% CI 0.49-0.88)， MACE的危险比为0.68 （95% CI 0.56-0.83）。在女性中，脑血管事件的hr为0.81 (95% CI 0.67-0.92)，冠状动脉事件的hr为0.73 (95% CI 0.57-0.95)， MACE的hr为0.79 （95% CI 0.67-0.92）。结论：2型糖尿病患者血清铁蛋白水平相对于其BMI高于预期，可能心血管事件的风险较低。这些发现表明，铁蛋白在心血管风险中发挥的作用可能比以前认为的更复杂，并强调了2型糖尿病管理中精细风险分层策略的潜力。

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来源期刊

Cardiovascular Diabetology 医学-内分泌学与代谢

CiteScore

12.30

自引率

15.10%

发文量

240

审稿时长

1 months

期刊介绍： Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.