Nutrition Metabolism and Cardiovascular Diseases最新文献

{"title":"The association between oils and fats consumption and the risk of premature coronary artery disease in a multi-centric case-control study: Iran premature coronary artery (IPAD)","authors":"Bahar Darouei ,&nbsp;Faezeh Tabesh ,&nbsp;Reza Amani-Beni ,&nbsp;Fatemeh Nouri ,&nbsp;Ehsan Zarepur ,&nbsp;Masoumeh Sadeghi ,&nbsp;Noushin Mohammadifard ,&nbsp;Nizal Sarrafzadegan","doi":"10.1016/j.numecd.2025.104516","DOIUrl":"10.1016/j.numecd.2025.104516","url":null,"abstract":"<div><h3>Background and aims</h3><div>The impact of different dietary fats on premature coronary artery disease (PCAD) has not been well established. Given Iran's ethnic diversity, this study examined the association between fat intake and the risk and severity of PCAD in multiple Iranian ethnicities.</div></div><div><h3>Methods and results</h3><div>In this multicenter case-control study, men aged &lt;55 and women aged &lt;65 years who were candidates for coronary angiography were recruited from major Iranian ethnicities. Intake of hydrogenated vegetable oil (HVO), non-hydrogenated vegetable oil (non-HVO), animal fat, and a composite fat consumption index (FCI) was assessed using a validated food frequency questionnaire and dichotomized at the median. Logistic regression models were fitted in three steps: crude, age- and sex-adjusted, and multivariate-adjusted. A total of 2459 participants were included: 1395 with PCAD and 1064 controls. The mean age was 51.47 ± 7.24. A higher non-HVO intake was associated with a lower risk of PCAD in the fully adjusted model (odds ratio [OR]: 0.37; 95 % confidence interval [CI]: 0.29, 0.46). This pattern was similar in the Fars (OR = 0.31), Kurdish (OR = 0.26), Bakhtiari (OR = 0.28), and Qashqaei (OR = 0.24) groups but not in the Azari group. Non-HVO intake was also associated with lower PCAD severity (OR: 0.31; 95 %CI 0.26, 0.37). No significant associations were observed between HVO, animal fat, or FCI. The interaction tests did not show any meaningful ethnic modifications.</div></div><div><h3>Conclusions</h3><div>Replacing solid and hydrogenated fats with liquid nonhydrogenated vegetable oils may reduce both the risk and severity of PCAD in Iranian adults and support dietary advice that prioritizes fat quality.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104516"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Omega-3 fatty acids and cardiovascular risk-related metabolic markers in diverse populations: a meta-analysis of randomized trials","authors":"Chen Chen ,&nbsp;Xuan Li ,&nbsp;Hongli Yan ,&nbsp;Junyan Liu ,&nbsp;Yuhang Cao ,&nbsp;Hongjiao Zhao ,&nbsp;Shixin Liu ,&nbsp;Yilin Wang ,&nbsp;Yifei Sun ,&nbsp;Beili Jia ,&nbsp;Junhua Yuan","doi":"10.1016/j.numecd.2025.104488","DOIUrl":"10.1016/j.numecd.2025.104488","url":null,"abstract":"<div><h3>Aim</h3><div>Many studies reported the effects of n-3 polyunsaturated fatty acids (PUFA) towards cardiovascular risk, but results are inconclusive. This meta-analysis systemically explored PUFA-mediated effects on representative cardiovascular-related metabolic markers, including glycolipid profile, adiponectin, and oxidative stress indicators in different people.</div></div><div><h3>Data synthesis</h3><div>Literature search on PubMed, EMBASE, Web of Science, and the Cochrane Library were performed up to October 11, 2024. Randomized controlled trials focusing on the effects of n-3 PUFA supplementation on triacylglycerol (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), apolipoprotein, adipokine, hemoglobin A1c (HbA1c), c-reactive protein (CRP), and oxidative stress biomarkers were chosen as outcome variables. There were 24 studies with 2043 subjects showed significant effects: (1)TG decreased by 16.95 mg/dl (21 trials, n = 1491; 95 % CI: 23.25, −10.66), (2)HDL increased by 1.55 mg/dl (22 trials, n = 1914; 95 % CI: 0.69, 2.42), (3)adiponectin increased by 0.96 μg/ml (3 trials, n = 198; 95 % CI: 0.03, 1.8), (4)HbA1c decreased by 0.17 % (3 trials, n = 283; 95 % CI: 0.29, −0.04), (5)LDL decreased by 10.98 mg/dl in women (4 trials, n = 236; 95 % CI: 19.41, −2.5) and by 13.77 mg/dl in the polycystic ovary syndrome (PCOS) (3 trials, n = 180; 95 % CI: 22.83, −4.7), (6)TC decreased by 15.58 mg/dl in women (4 trials, n = 236; 95 % CI: 24.64, −6.53).</div></div><div><h3>Conclusions</h3><div>The meta-analysis indicates that n-3 PUFAs improve cardiovascular-related metabolic markers, potentially benefit cardiovascular health in patients with cardiovascular disease, PCOS, and kidney disease, especially in older women via reducing TG and HbA1c and increasing HDL and adiponectin.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104488"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pro‐ and Anti‐Inflammatory properties of neutrophils and CRP: Some points for consideration","authors":"Zohreh Jadali","doi":"10.1016/j.numecd.2025.104512","DOIUrl":"10.1016/j.numecd.2025.104512","url":null,"abstract":"","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104512"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing the drivers of obesity: Integrating commercial determinants and metabolic diversity into post-pharmacotherapy strategies","authors":"Chutharat Thanchonnang ,&nbsp;Schawanya K. Rattanapitoon ,&nbsp;Patpicha Arunsan ,&nbsp;Nathkapach K. Rattanapitoon","doi":"10.1016/j.numecd.2025.104480","DOIUrl":"10.1016/j.numecd.2025.104480","url":null,"abstract":"","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104480"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caffeine metabolic phenotypes and hypertension risk: Urinary paraxanthine-to-caffeine ratio threshold and mediating pathways in NHANES","authors":"Fang-e Shi ,&nbsp;Zhengyi Huang ,&nbsp;Lingjie Cao ,&nbsp;Zhe Yu ,&nbsp;Cheng Chi","doi":"10.1016/j.numecd.2025.104525","DOIUrl":"10.1016/j.numecd.2025.104525","url":null,"abstract":"<div><h3>Background and aims</h3><div>This study aimed to resolve the caffeine-hypertension paradox by investigating the association between urinary paraxanthine-to-caffeine molar ratio (PMR)—a functional biomarker of CYP1A2 metabolic capacity—and hypertension risk, while exploring mediation by serum uric acid (SUA) and white blood cells (WBC).</div></div><div><h3>Methods and results</h3><div>Using nationally representative NHANES data (2009–2014; n = 1611), urinary PMR was quantified via UPLC-ESI-MS/MS. Hypertension was defined per AHA/ACC 2017 guidelines. Multivariable logistic regression analyzed PMR-hypertension associations (unadjusted, age/sex-adjusted, fully adjusted). Dose-response relationships were modeled using restricted cubic spline (RCS) analysis. Causal mediation tested SUA/WBC pathways. Faster caffeine metabolism (higher PMR) demonstrated a nonlinear inverse relationship with hypertension. A critical inflection point at PMR = 3.03 revealed: slow metabolizers (PMR &lt;3.03) had 51 % higher hypertension risk than fast metabolizers (OR = 0.49, 95 % CI: 0.40–0.60; P &lt; 0.001). SUA and WBC collectively mediated 12 % of PMR's protective effect (SUA: 8.0 %; WBC: 4.0 %). Subgroup analyses showed effect modification by age and race (<em>P</em> interaction &lt;0.05).</div></div><div><h3>Conclusion</h3><div>PMR serves as a novel biomarker clarifying the caffeine-hypertension paradox: fast metabolizers (PMR ≥3.03) exhibit significantly reduced hypertension risk, partially mediated by reduced SUA and inflammation. This supports personalized caffeine intake recommendations based on metabolic phenotype.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104525"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal associations between fast food outlet count and inflammatory markers in the US-based nurses’ health study II between 1998 and 2011","authors":"Noreen Z. Siddiqui ,&nbsp;Joline W.J. Beulens ,&nbsp;Jaime E. Hart ,&nbsp;Jochem O. Klompmaker ,&nbsp;Joreintje D. Mackenbach ,&nbsp;Maria G.M. Pinho ,&nbsp;Eric B. Rimm ,&nbsp;Peter James","doi":"10.1016/j.numecd.2025.104476","DOIUrl":"10.1016/j.numecd.2025.104476","url":null,"abstract":"<div><h3>Background and aims</h3><div>Inflammation is an established cardiovascular disease risk factor, but its role in the link between food environments and cardiovascular risk remains unexplored.</div><div>We aimed to study longitudinal associations between residential fast food outlets (FFOs) and inflammatory markers in US females from the Nurses’ Health Study II with stored blood and residential addresses.</div></div><div><h3>Methods and results</h3><div>We counted FFOs within 1500-m buffers around each address in 1998 and 2010. In samples collected at two time points (1999, 2011), we measured C-reactive protein (CRP, N = 1350), Interleukin-6 (IL-6, N = 809), and adiponectin (N = 836). We performed multivariable linear regression with repeated measures to study changes in FFOs and inflammatory markers and multivariable linear regression analyses to study FFOs count in 1998 and changes in inflammatory markers between 1999 and 2011. Models were adjusted for age, race/ethnicity, partners’ education, smoking, neighborhood socioeconomic status (nSES), and population density. We explored effect modification by nSES and population density. No associations were observed in linear mixed models (e.g., CRP (β: 0.00, 95 %CI: 0.01,0.01) or in linear models including changes in inflammatory outcomes (e.g., CRP (β:0.00, 95 %CI: 0.01, 0.02). We also observed no effect modification for nSES or population density.</div></div><div><h3>Conclusion</h3><div>In conclusion, we found no evidence for longitudinal associations between FFOs count and inflammatory markers in this study.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104476"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlated factors and prognostic importance of reduction in liver stiffness measurement in individuals with type 2 diabetes and MASLD","authors":"Claudia R.L. Cardoso,&nbsp;Cristiane A. Villela-Nogueira,&nbsp;Gil F. Salles,&nbsp;Nathalie C. Leite","doi":"10.1016/j.numecd.2025.104478","DOIUrl":"10.1016/j.numecd.2025.104478","url":null,"abstract":"<div><h3>Background and aim</h3><div>Reduction in liver fibrosis, as assessed by liver stiffness measurement (LSM) on serial vibration-controlled transient elastography (VCTE) examinations, may have beneficial effects on development of liver-related and cardiovascular outcomes in individuals with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD).</div></div><div><h3>Methods and results</h3><div>A prospective cohort of 288 individuals with type 2 diabetes and MASLD performed 2 VCTE exams at least two years apart, and significant LSM reduction was defined as &gt;20 % decrease. Logistic regression assessed the independent correlates of having LSM reduction and multivariable Cox analyses assessed associations between LSM reduction and liver-related and cardiovascular outcomes.</div><div>Eighty-six individuals (30 %) had a reduction in LSM &gt;20 %; its independent correlates were a lower aspartate aminotransferase (AST ≤20 U/L) and HbA_1c (≤7 %) levels closest to the 2nd VCTE exam, the use of statins and having the wild CC genotype of the PNPLA3 gene. Over a median follow-up of 6 years, there were 22 liver-related and 28 cardiovascular events. Reduction in LSM was associated with a significant 78 % lower risk of liver events and 62 % lower cardiovascular risk.</div></div><div><h3>Conclusions</h3><div>Using statins and achieving good glycemic control are associated with higher chances of having liver fibrosis reduction, and serum AST reduction may be a biomarker of such improvement. Having LSM reduction on serial VCTE examinations is associated with lower risks of adverse cardiovascular and liver-related events and, if further confirmed, it might be a treatment goal in individuals with type 2 diabetes and MASLD.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104478"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High atherogenic index of plasma increased the risk of new-onset hypertension","authors":"Zhong-Yuan Meng ,&nbsp;Sen-Hu Tang ,&nbsp;Lan-Xian Mai ,&nbsp;Chuang-Hong Lu ,&nbsp;Jing Li ,&nbsp;Jia-Ping Li ,&nbsp;Sheng-Lin Xian ,&nbsp;Zhi-Yu Zeng","doi":"10.1016/j.numecd.2025.104486","DOIUrl":"10.1016/j.numecd.2025.104486","url":null,"abstract":"<div><h3>Background and aim</h3><div>The atherogenic index of plasma (AIP), calculated as log10 (triglyceride/high-density lipoprotein cholesterol, TG/HDL-C), has been proposed as a reliable marker for evaluating lipid-related atherosclerotic risk. However, the association between AIP and new-onset hypertension (HTN) remains controversial. This study aimed to investigate the relationship between AIP and new-onset HTN and to explore the potential mediating role of body mass index (BMI).</div></div><div><h3>Methods and results</h3><div>This prospective cohort study included adult participants without HTN at baseline who were enrolled from a large community-based health screening program between 2014 and 2023. Baseline clinical characteristics, anthropometric parameters, and biochemical indices were collected. Restricted cubic spline (RCS) analysis was used to determine the inflection point of AIP for grouping participants into low- and high-AIP categories. Propensity score matching (PSM) was applied to balance baseline confounders between groups. The cumulative incidence of HTN was compared using cumulative risk curves and log-rank tests. Multivariate Cox proportional hazards models were employed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Mediation analysis was performed to assess whether BMI mediated the relationship between AIP and new-onset HTN. The results showed participants with higher baseline or cumulative AIP values had a significantly higher risk of developing HTN (log-rank p &lt; 0.001). After multivariable adjustment, individuals in the high-AIP group exhibited an elevated risk of new-onset HTN (HR = 1.42, 95 % CI 1.25–1.61, p &lt; 0.001) compared with those in the low-AIP group. BMI partially mediated the association between AIP and HTN, accounting for approximately 5.76 % of the total effect (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>A high AIP increased the risk of new HTN. BMI potentially mediated the association between the AIP and new-onset HTN.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104486"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body roundness index and cardiometabolic multimorbidity: Findings from the English Longitudinal Study of Ageing","authors":"Setor K. Kunutsor ,&nbsp;Atanu Bhattacharjee ,&nbsp;Sae Young Jae ,&nbsp;Jari A. Laukkanen","doi":"10.1016/j.numecd.2025.104475","DOIUrl":"10.1016/j.numecd.2025.104475","url":null,"abstract":"<div><h3>Background and aims</h3><div>Evidence on the association of Body Roundness Index (BRI), an anthropometric indicator of body fat and visceral adiposity, with cardiometabolic multimorbidity (CMM) remains limited. This study aimed to compare the associations and predictive utilities of BRI and body mass index (BMI) for CMM.</div></div><div><h3>Methods and results</h3><div>We analyzed data from 3348 adults (mean age 63 years; 45.1 % male) in the English Longitudinal Study of Ageing, free of major cardiometabolic conditions at baseline (2008–2009). BRI was derived from height and waist circumference. CMM was defined as having ≥2 of the following by 2021–2023: hypertension, cardiovascular disease, diabetes, or stroke. Multivariable odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated. During 12–15 years of follow-up, 197 participants (5.9 %) developed CMM. Both BRI and BMI showed linear dose–response relationships with CMM risk (<em>p</em> for nonlinearity &gt;0.05). Higher BRI was associated with increased odds of CMM (per 1-SD: OR 1.33, 95 % CI 1.17–1.53; top vs bottom tertile: OR 1.89, 95 % CI 1.23–2.90), with similar findings for BMI. Adding BRI to conventional risk models modestly improved discrimination (ΔC-index = 0.0082, <em>p</em> = .26) and significantly improved model fit (<em>p</em> &lt; .001). Gains for BMI were smaller (ΔC-index = 0.0049, <em>p</em> = .46), with BRI offering a slightly greater improvement in predictive performance (Δ = 0.0033, <em>p</em> = .40).</div></div><div><h3>Conclusion</h3><div>Both BRI and BMI were independently and linearly associated with an increased risk of CMM. BRI showed slightly stronger predictive performance than BMI.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104475"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of machine learning for sex-specific risk prediction of coronary artery calcification","authors":"Mohamad Jamalinia ,&nbsp;Giovanni Targher ,&nbsp;Amedeo Lonardo ,&nbsp;Seyed Taghi Heydari ,&nbsp;Kamran Bagheri Lankarani","doi":"10.1016/j.numecd.2026.104579","DOIUrl":"10.1016/j.numecd.2026.104579","url":null,"abstract":"<div><h3>Background and aims</h3><div>Sex-related differences in coronary artery calcium (CAC) burden and risk are well known but often ignored in traditional models. We aimed to determine whether sex-specific machine learning (ML) improves CAC risk prediction using routine clinical data.</div></div><div><h3>Methods and results</h3><div>In this cross-sectional study, adults (n = 446) referred for coronary computed tomography angiography were included. The data were subdivided into training (127 men, 185 women) and test (55 men, 79 women) sets. Eight ML classifiers were trained on the overall training dataset and separately for men and women to predict CAC presence (0 vs. &gt;0), severity (0, 1–99, ≥100), and distribution (0, 1-vessel, ≥2-vessel). Algorithm performance was assessed on the unseen test set. CAC was present in 44.2 % of participants, with 17.4 % having CAC≥100 and 23.3 % having multivessel involvement (≥2 vessels). Sex-specific ML improved CAC prediction performance. For CAC presence, top-performing models achieved AUC/F1-scores of 0.690/0.618 overall, 0.799/0.776 in men, and 0.679/0.594 in women. For CAC severity, results were 0.692/0.532 overall, 0.731/0.584 in men, and 0.748/0.562 in women. For CAC distribution, AUC/F1-scores were 0.694/0.596 overall, 0.696/0.551 in men, and 0.738/0.615 in women. Threshold analysis in binary CAC classification (0 vs. &gt;0) showed reasonable rule-out performance in both sexes, while rule-in performance was acceptable only in men. Feature importance rankings showed significant differences between sexes, reflecting sex-specific learning patterns.</div></div><div><h3>Conclusions</h3><div>Sex-specific ML improved CAC risk prediction, highlighting algorithmic sex-related differences in cardiovascular risk assessment. These findings support the development of sex-specific cardiovascular risk equations to enhance personalized care and treatment.</div></div>","PeriodicalId":49722,"journal":{"name":"Nutrition Metabolism and Cardiovascular Diseases","volume":"36 4","pages":"Article 104579"},"PeriodicalIF":3.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}