Cardiovascular Diabetology最新文献

{"title":"Joint effects of triglyceride glucose index and its obesity-related derivatives with estimated glucose disposal rate on cardiometabolic multimorbidity in middle-aged and older Chinese adults: a nationwide cohort study.","authors":"Xianlin Ruan, Yihang Ling, Jinming Chen, Yulong Xiang, Huangtao Ruan, Weipeng Zhang, Ling Jing, Xin Gao, Yibo He, Xiaozhao Lu, Tian Chang, Junyan Xu, Jiyan Chen","doi":"10.1186/s12933-025-02939-7","DOIUrl":"https://doi.org/10.1186/s12933-025-02939-7","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), and estimated glucose disposal rate (eGDR) serve as surrogate markers of insulin resistance (IR) and are associated with cardiometabolic diseases (CMDs). However, the joint effects of TyG-related indices and eGDR on cardiometabolic multimorbidity (CMM) risk remains unclear. This study aims to assess both separate and combined effects of TyG-related indices and eGDR on CMM.</p><p><strong>Methods: </strong>The data of this study derived from the China Health and Retirement Longitudinal Study (CHARLS). TyG-related indices and eGDR were dichotomized at their median levels for participant categorization. Univariate and multivariate Cox regression and restricted cubic splines (RCS) analyzed effects of TyG-related indices and eGDR on CMM, while receiver operating characteristic (ROC) curves, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) assessed their predictive performance. Meanwhile, the mutual mediating effects and interaction effects were further assessed.</p><p><strong>Results: </strong>This study included 5,854 participants (male: 47.5%, median age: 57.0 years). Compared to low TyG-related indices plus high eGDR, High TyG-related indices plus low eGDR had elevated CMM risks: TyG (HR 3.59, 95% CI 2.28-5.65), TyG-BMI (HR 3.40, 95% CI 2.30-5.02), TyG-WC (HR 3.85, 95% CI 2.58-5.75), and TyG-WHtR (HR 3.62, 95% CI 2.43-5.39). Furthermore, the addition of TyG-related indices combined with eGDR to the basic model significantly improved CMM risk prediction: TyG (AUC 0.713, NRI 0.363, IDI 0.008, all p < 0.05); TyG-BMI (AUC 0.729, NRI 0.479, IDI 0.011, all p < 0.05); TyG-WC (AUC 0.716, NRI 0.419, IDI 0.010, all p < 0.05); and TyG-WHtR (AUC 0.717, NRI 0.379, IDI 0.010, all p < 0.05). Moreover, the mediation analysis demonstrated that eGDR significantly mediated all TyG-related indices' associations with CMM, with only obesity-related TyG indices mediating the association between eGDR and CMM. Notably, no significant additive or multiplicative interaction was observed between any TyG-related indices and eGDR for CMM risk.</p><p><strong>Conclusions: </strong>High TyG-related indices and low eGDR were independently and jointly associated with higher CMM risk. Joint application of TyG-related indices and eGDR could improve early identification and prevention of CMM.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"382"},"PeriodicalIF":10.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testosterone therapy is associated with reduced risk of acute kidney injury, kidney failure with renal replacement therapy, and cardiovascular events in men with diabetes and hypogonadism.","authors":"Fabrice Bonnet, Patricia Vaduva, Jean-Michel Halimi, Arnaud Dosda, Pierre-Henri Ducluzeau, Laetitia Koppe, Laurent Fauchier","doi":"10.1186/s12933-025-02930-2","DOIUrl":"https://doi.org/10.1186/s12933-025-02930-2","url":null,"abstract":"<p><strong>Background: </strong>Testosterone deficiency is common in men with diabetes. Effects of testosterone therapy on kidney failure and cardiovascular outcomes in diabetic men remain poorly understood. Our aim was to assess whether testosterone therapy is associated with reduced risk of acute kidney injury and kidney failure requiring replacement therapy in men with diabetes and hypogonadism compared to matched untreated men with diabetes.</p><p><strong>Methods: </strong>Participants were recruited from the TriNetX Research Collaborative network. We identified 26,027 diabetic men with hypogonadism treated with testosterone and matched them 1:1 using propensity score matching to 26,027 untreated diabetic men with hypogonadism. Primary outcomes were acute kidney injury and kidney failure requiring replacement therapy (dialysis or transplantation). Secondary outcomes included myocardial infarction, ischemic stroke, atrial fibrillation, and all-cause mortality. Cox proportional hazard models were used over a mean follow-up of 3.3 years.</p><p><strong>Results: </strong>Men had a mean age of 58 years (SD 12), with 71% being non-Hispanic White. Testosterone-treated men had significantly lower risk of acute kidney injury (HR: 0.93 [95% CI 0.87-0.98], p = 0.01) and kidney failure with replacement therapy (HR: 0.81 [95% CI 0.72-0.92], p = 0.001) compared to untreated men. Testosterone therapy was also associated with reduced risk of myocardial infarction (HR: 0.85 [95% CI 0.78-0.93], p < 0.0001), ischemic stroke (HR: 0.88 [95% CI 0.80-0.97], p = 0.01), atrial fibrillation (HR: 0.91 [95% CI 0.85-0.98], p = 0.01), and all-cause mortality (HR: 0.85 [95% CI 0.79-0.91], p < 0.0001).</p><p><strong>Conclusions: </strong>In this large real-world cohort study, testosterone therapy in diabetic men with hypogonadism was associated with significant reductions in acute kidney injury, kidney failure requiring replacement therapy, major cardiovascular events, and total mortality. These findings suggest that testosterone therapy could be more readily considered for men with diabetes and hypogonadism as a potential intervention to prevent kidney injury.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"378"},"PeriodicalIF":10.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between metabolic score for insulin resistance and future stroke risk in patients with cardiovascular-kidney-metabolic syndrome stages 0-3: a longitudinal analysis based on CHARLS.","authors":"Huihong Wu, Yang Zhou, Xinxing Lai, Bin Ma, Lu Ding, Xiaojie Zhu, Zixin Chen, Ziwang Liu","doi":"10.1186/s12933-025-02932-0","DOIUrl":"https://doi.org/10.1186/s12933-025-02932-0","url":null,"abstract":"<p><strong>Background: </strong>Metabolic disorders, cardiovascular diseases, and chronic kidney diseases are closely interrelated, and the proposal of cardiovascular-kidney-metabolic (CKM) syndrome concept has received extensive attention.The disease burden of CKM is heavy, with stroke being a significant contributor, and CKM staging is bidirectional.A large body of evidence has demonstrated that insulin resistance is closely associated with diseases such as stroke, obesity and chronic kidney disease. While the metabolic score for insulin resistance (METS-IR) serves as an important indicator for evaluating insulin resistance, the relationship between METS-IR and stroke incidence remains unclear in the population defined by CKM syndrome stages 0-3.</p><p><strong>Methods: </strong>In this study, data on individuals with CKM syndrome stages 0-3 without stroke at baseline were collected from China Health and Retirement Longitudinal Study (CHARLS).Self-reported stroke was used as the primary outcome, with METS-IR at baseline as the exposure factor. Logistic regression was performed to analyze the effect of METS-IR on the incidence of stroke among participants with CKM, and restricted cubic spline (RCS) regression was utilized to explore the potential nonlinear relationship between them. To evaluate the predictive value of METS-IR for stroke risk in individuals with CKM syndrome stages 0-3, we applied receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>A total of 5009 participants were included in this study, with a mean age of 60.48 ± 8.81 years. Over a 5-year follow-up, 339 participants in this study developed incident stroke. Participants were stratified into METS-IR quartiles (Q1-Q4). In the fully adjusted model, compared with Q1 (the lowest quartile), the odds ratio (OR) for Q3 was 1.88 (95% CI: 1.25-2.81; P = 0.002), and the OR for Q4 was 1.72 (95% CI: 1.08-2.76; P = 0.02). RCS analysis revealed a nonlinear relationship between METS-IR and stroke risk among participants with CKM syndrome stages 0-3 (P-overall < 0.05; P-nonlinearity < 0.05). ROC analysis showed an area under the curve (AUC) of 0.726 (95% CI: 0.699-0.752), with an optimal METS-IR cutoff value of 29.58.</p><p><strong>Conclusions: </strong>In individuals with CKM syndrome stages 0-3, elevated METS-IR levels may be associated with an increased stroke risk. Furthermore, METS-IR demonstrates moderate predictive value for stroke risk in this population. Monitoring METS-IR may therefore aid in their early identification.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"379"},"PeriodicalIF":10.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endocrine-disrupting chemicals exposure: cardiometabolic health risk in humans.","authors":"Cheng-Xu Ma, Xiao-Ni Ma, Hong-Li Li, Dídac Mauricio, Song-Bo Fu","doi":"10.1186/s12933-025-02938-8","DOIUrl":"https://doi.org/10.1186/s12933-025-02938-8","url":null,"abstract":"<p><p>Endocrine-disrupting chemicals (EDCs) are exogenous compounds that interfere with hormone action, and growing evidence suggests that human exposure to certain EDCs may increase the risk of obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD). To clarify the impact of EDC exposure on cardiometabolic health, we conducted a review of the literature (2005-2025) to identify both human epidemiological studies and animal mechanistic studies. In this narrative review, we primarily summarize the existing human epidemiological evidence on the cardiometabolic effects of EDCs, while also considering mechanistic insights, including selected animal studies, to illustrate biological plausibility. Key findings indicate that EDC exposures are consistently associated with elevated risks of cardiometabolic conditions. Notably, prenatal and early-life EDC exposures appear to increase susceptibility to obesity, impaired glucose metabolism, and cardiovascular dysfunction later in life, while adult exposures are linked to a higher incidence of metabolic syndrome, type 2 diabetes, and related cardiovascular complications. In conclusion, this review underscores EDC exposure as a significant environmental risk factor for cardiometabolic disease. Accordingly, strengthening regulatory policies to reduce human exposure to these chemicals-alongside further research into underlying mechanisms-may be crucial for improving cardiometabolic health outcomes.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"381"},"PeriodicalIF":10.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triglyceride glucose index in patients with acute coronary syndrome undergoing percutaneous coronary intervention predicts cardiovascular events: a cohort study.","authors":"Senlin Hu, Haoyu Yan, Yang Sun, Daowen Wang, Hesong Zeng, Guanglin Cui","doi":"10.1186/s12933-025-02937-9","DOIUrl":"https://doi.org/10.1186/s12933-025-02937-9","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence has highlighted the connection between the Triglyceride-glucose (TyG) index and the development and severity of coronary artery disease. However, the role of the TyG index in predicting adverse cardiovascular outcomes among patients who have undergone percutaneous coronary intervention (PCI) remains underexplored.</p><p><strong>Methods: </strong>Our study encompassed 8019 individuals with acute coronary syndrome (ACS) who had PCI, sourced from the ongoing perspective, observational, single-center COSTIC research. We gathered data on baseline clinical characteristics and the TyG index. The primary endpoints were major adverse cardiovascular events (MACE), which included cardiovascular death, all-cause death, myocardial infarction, and stroke. To examine the relationship between the TyG index and cardiovascular outcomes, we utilized multivariate Cox proportional hazards models and restricted cubic splines.</p><p><strong>Results: </strong>During the 1-year follow-up period, we documented 341 MACEs, comprising 197 cardiovascular deaths and 242 all-cause deaths. The TyG index was associated with a higher risk of MACE (hazard ratio [HR]: 1.246, 95% confidence interval [CI] 1.064 to 1.459, p = 0.006), cardiovascular death (HR: 1.409, 95% CI 1.150 to 1.727, p = 0.001) and all-cause death (HR: 1.368, 95% CI 1.133 to 1.652, p = 0.001) for each interquartile range (IQR) increment. Stratified analyses unveiled significant interactions between the TyG index and variables such as sex, smoking status, and ACS diagnosis (p for interaction < 0.05). Nevertheless, restricted cubic splines analysis did not detect a non-linear relationship between the TyG index and MACE (p-non-linear = 0.971), cardiovascular mortality (p-non-linear = 0.684), or all-cause mortality (p-non-linear = 0.827).</p><p><strong>Conclusions: </strong>Our findings underscore a significant association between the TyG index and adverse cardiovascular outcomes, including cardiovascular and all-cause mortality, in ACS patients following PCI. The TyG index may thus function as an early predictor of cardiovascular risk or a potential therapeutic target in the management of cardiovascular disease.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"380"},"PeriodicalIF":10.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An ensemble machine learning-based risk stratification tool for 30-day mortality prediction in critically ill cardiovascular patients.","authors":"Mingxing Lei, Xiao Liu, Longcan Cheng, Yan Li, Nan Tang, Jie Song, Mi Song, Qingqing Su, Mingxuan Liu, Shihui Fu, Baisheng Sun, Yuan Gao","doi":"10.1186/s12933-025-02911-5","DOIUrl":"10.1186/s12933-025-02911-5","url":null,"abstract":"<p><strong>Background: </strong>Early mortality prediction in critically ill patients with cardiovascular disease remains challenging. This study aimed to develop and validate an ensemble machine learning (ML) model to predict 30-day mortality, comparing its performance with conventional severity scores and interrogating the incremental prognostic value of stress hyperglycemia ratio (SHR).</p><p><strong>Methods: </strong>A retrospective cohort of 1,595 ICU patients with cardiovascular disease combined with diabetes (2008-2022) was analyzed. SHR was calculated as admission glucose divided by estimated average glucose (eAG) from HbA1c. Six ML models (eXtreme Gradient Boosting [XGBoost], Decision Tree [DT], Random Forest [RF], Artificial Neural Network [ANN], Logistic Regression [LR], and Support Vector Machine [SVM]) were trained on 80% of the data, with the top three performers combined into an ensemble model. Model performance was evaluated using area under the curve (AUC), precision-recall, calibration, and clinical utility metrics.</p><p><strong>Results: </strong>The 30-day mortality rate was 10.8% in the entire cohort (n = 173). The ensemble model demonstrated superior predictive performance with an AUC of 0.912 (95% CI: 0.888-0.936), outperforming both individual ML models (XGBoost, AUC = 0.903) and traditional scoring systems (APS III/SOFA/SAPS II AUCs ≤ 0.742; all P < 0.001). The top six important predictors included anti-hypertensives, aspirin, blood urea nitrogen (BUN), white blood cell (WBC), age, and red blood cell (RBC), with the Shapley Additive Explanations analysis revealing clinically meaningful patterns: a nonlinear risk escalation for age, linear risk increases with rising BUN and bilirubin levels, a protective effect associated with higher RBC counts, and both low and high WBC levels linked to increased early death risk. While SHR significantly improved the performance of traditional scoring systems (e.g., increasing SOFA AUC from 0.741 to 0.757, P = 0.010), its addition to the ensemble model provided limited incremental benefit (ΔAUC = - 0.032, P = 0.094). External validation in an independent cohort (n = 307) confirmed the model's robustness (AUC = 0.891, 95% CI: 0.864-0.917), with decision curve analysis demonstrating superior clinical utility across a wide range of risk thresholds.</p><p><strong>Conclusions: </strong>The ensemble ML model outperformed conventional prognostic tools in predicting 30-day mortality, with SHR augmenting traditional tools but not the ensemble ML model. This approach offers a reliable, interpretable framework for risk stratification in high-risk cardiovascular patients.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"373"},"PeriodicalIF":10.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of six insulin resistance-related indices with the risk and progression of cardio-renal-metabolic multimorbidity: evidence from the UK biobank.","authors":"Lulu Liu, Guangzan Yu, Xuhou Ji, Yunlong Wang, Hua He","doi":"10.1186/s12933-025-02928-w","DOIUrl":"10.1186/s12933-025-02928-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Insulin resistance (IR)-related indices are increasingly recognized as important contributors to cardio-renal-metabolic (CRM) diseases. However, most prior studies have focused on isolated outcomes or cross-sectional disease status, lacking dynamic insight into disease progression. This study aimed to evaluate the predictive value of six IR-related indices for CRM onset and multistage progression using multistate modeling, and to explore potential biological mechanisms through mediation analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We included 327,692 CRM-free participants from the UK Biobank in this prospective cohort study. Six IR-related indices including triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR), triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio, and metabolic score for insulin resistance (METS-IR), were calculated using established formulas. Cox proportional hazards and multistate models were used to assess associations with CRM incidence and progression. Predictive performance was evaluated using area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Mediation analysis was conducted for inflammatory, hepatic, and renal biomarkers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over a mean follow-up of 13.6 years, 17.3% (n = 58,563) of participants developed at least one CRM disease. All six IR-related indices were significantly associated with CRM multimorbidity, both in terms of incidence and progression. In predicting the incidence of CRM diseases, TyG-WC, TyG-WHtR, and METS-IR demonstrated superior performance. For each 1-standard deviation (SD) increase in TyG-WC, the risks of developing first, double, and triple CRM diseases increased by 51.4%, 88.6%, and 128.7%, respectively (all P &lt; 0.001), with similar gradients observed for TyG-WHtR and METS-IR. Multistate Cox models further confirmed consistent associations between IR-related indices and CRM progression, particularly for TyG-WHtR and TyG. Specifically, a 1-SD increase in TyG-WHtR was associated with a 65.3% increased risk of transitioning from healthy to first CRM disease, 34.6% from first to double, and 26.7% from double to triple CRM diseases (all P &lt; 0.001). In predictive performance evaluation, TyG-WC, TyG-WHtR, and METS-IR achieved the highest AUC, NRI, and IDI values. Mediation analyses indicated that systemic inflammation, organ function, and especially kidney function partially mediated the observed associations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In summary, IR-related indices, particularly TyG-WC, TyG-WHtR, and METS-IR, were observed to be associated with the presence and progression of CRM diseases. Their potential incorporation into risk assessment and prevention strategies, together with consideration of inflammatory and organ function pathways, might help reduce the burden of CRM mult","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"377"},"PeriodicalIF":10.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planetary health diet, other plant-based diets and risk of type 2 diabetes: a prospective study from the UK Biobank.","authors":"María Del Carmen Aznar de la Riera, Rosario Ortolá, Stefanos N Kales, Esther García-Esquinas, Fernando Rodríguez-Artalejo, Mercedes Sotos-Prieto","doi":"10.1186/s12933-025-02909-z","DOIUrl":"10.1186/s12933-025-02909-z","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes remains a major global health concern, and plant-based diets (PBD) offer substantial preventive value. The Planetary Health Diet Index (PHDI) captures adherence to an environmentally sustainable PBD with potential metabolic benefits. However, evidence on its association with type 2 diabetes risk remains limited, notably in comparison with other preexisting PBD. The objective of this study was to evaluate the association between adherence to the PHDI and type 2 diabetes risk in a large British adult cohort and compare it to other well-known PBDs.</p><p><strong>Methods: </strong>This analysis included 112,032 participants aged 40-69 years from the UK Biobank who were free of type 2 diabetes and cardiovascular disease at baseline (2009-2012) and were followed until 2021. Dietary intake was assessed using at least two 24-h dietary recalls, and PHDI scores (range: 0-130) were computed based on adherence to 14 food groups recommendations. The other PBDs (alternate Mediterranean Diet score (aMED), healthful plant-based index (hPBD), Dietary Approach to Stop Hypertension (DASH), and Alternate Healthy Eating Index (AHEI-2010)), were estimated using established methodologies. Incident type 2 diabetes was ascertained through clinical records, hospital admissions, and self-reporting. Cox proportional-hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs), adjusting for key confounders.</p><p><strong>Results: </strong>During a median 9.4-year follow-up, 2666 cases of type 2 diabetes were identified. When comparing participants in the highest versus the lowest quartile of PHDI adherence, the multivariable-adjusted HR (95% CI) for type 2 diabetes was 0.57 (0.50, 0.64), which was more pronounced than that observed for the aMED: 0.70 (0.62, 0.78) and hPDI: 0.64 (0.57, 0.72) and similar to DASH: 0.58 (0.51, 0.65); AHEI-2010: 0.59 (0.53, 0.67). Further adjustment for BMI led to a 13-19% attenuation of the association. High consumption of vegetables and fish, and limited intake of red/processed meats and added sugars were associated with reduced type 2 diabetes risk.</p><p><strong>Conclusions: </strong>In this large cohort of British adults, higher adherence to the PHDI was associated with a substantially lower risk of type 2 diabetes, with effect sizes comparable to or greater than those observed for other well-known PBDs. These findings support the promotion of the PHDI and PBDs as an environmentally sustainable choice with potential to reduce type 2 diabetes risk.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"376"},"PeriodicalIF":10.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type 2 diabetes, sodium-glucose cotransporter-2 inhibitors and cardiovascular outcomes: real world evidence versus a randomised clinical trial.","authors":"Puriya Daniel Würtz Yazdanfard, Kathrine Kold Sørensen, Bochra Zareini, Ulrik Pedersen-Bjergaard, Johan Sebastian Ohlendorff, Anders Munch, Mikkel Porsborg Andersen, Rasmus Bo Hasselbalch, Henrik Imberg, Viktor Tasseleus, Marcus Lind, Jonathan Valabhji, Pratik Choudhary, Kamlesh Khunti, Stefanie Schmid, Stefanie Lanzinger, Julia Mader, Thomas Alexander Gerds, Christian Torp-Pedersen","doi":"10.1186/s12933-025-02924-0","DOIUrl":"10.1186/s12933-025-02924-0","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits in randomised controlled trials (RCT). However, the controlled nature of RCTs and the selected trial populations limit their generalizability to real-world practice. Substantial methodological advances now enable robust estimation of absolute risks, risk differences, and continuous on-treatment effects, providing more clinically interpretable measures of SGLT2i effectiveness than previously possible with traditional models reliant on hazard ratios.</p><p><strong>Methods: </strong>We conducted a target trial emulation using nationwide Danish registries to evaluate the real-world effectiveness of SGLT2i versus dipeptidyl peptidase-4 inhibitors (DPP4i) in individuals with type 2 diabetes (T2D) and cardiovascular disease (CVD). Outcomes included major adverse cardiovascular events (MACE), heart failure hospitalizations, and all-cause mortality. Absolute risks and risk differences for three years of continuous treatment were estimated using longitudinal targeted minimum loss-based estimation, adjusting for baseline and time-varying confounders.</p><p><strong>Results: </strong>Among 116,823 patients who redeemed SGLT2i or DPP4i for the first time, 13,524 met inclusion and exclusion criteria (SGLT2i: 6,025; DPP4i: 7,499). At three years, the risk of MACE was 11.5% for SGLT2i users versus 14.2% for DPP4i users (risk-difference: 2.8 percentage-points, 95% CI: 1.1-4.4%). Heart failure hospitalizations were lower by 5.1 percentage-points (95% CI: 4.3-6.0%), and all-cause mortality by 3.1 percentage-points (95% CI: 1.5-4.7%), all favoring SGLT2i. Notably, we also observed a risk reduction in stroke by 2.4 percentage-points (95% CI: 1.7-3.1%).</p><p><strong>Conclusions: </strong>This study demonstrates the real-world effectiveness of continuous SGLT2i treatment in reducing cardiovascular events in patients with T2D and CVD. The absolute benefit of SGLT2i was larger in a real world population than in the intention to treat estimate in clinical trials.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"371"},"PeriodicalIF":10.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relation of the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio to residual risk in anticoagulated patients with atrial fibrillation: a report from the prospective Murcia AF Project III cohort.","authors":"Eva Soler-Espejo, Yang Chen, José Miguel Rivera-Caravaca, María Pilar Ramos-Bratos, María Asunción Esteve-Pastor, Francisco Marín, Vanessa Roldán, Gregory Y H Lip","doi":"10.1186/s12933-025-02927-x","DOIUrl":"10.1186/s12933-025-02927-x","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) confers a high risk of thromboembolism and cardiovascular events, which persists despite optimal oral anticoagulation (OAC). The non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) integrates pro- and anti-atherogenic lipid fractions and has been linked to adverse outcomes in high-risk patient populations. The prognostic value of NHHR in anticoagulated AF patients is uncertain. We aimed to evaluate NHHR as a marker of residual thromboembolic and cardiovascular risk in this population.</p><p><strong>Methods: </strong>Consecutive AF outpatients initiating OAC between January 2016 and November 2021 were enrolled in this prospective cohort study. NHHR was calculated from baseline non-HDL-C and HDL-C levels, and patients were stratified into two groups. Primary outcomes were thromboembolic events (i.e., composite of ischaemic stroke (IS), transient ischaemic attack (TIA), or systemic embolism) and major adverse cardiovascular events (MACE), comprising myocardial infarction, IS, TIA, or cardiovascular death. Secondary outcomes included cardiovascular and all-cause death. Restricted cubic spline (RCS) models assessed non-linear associations, and multivariable Cox models evaluated associations between NHHR and outcomes.</p><p><strong>Results: </strong>1694 patients (52.8% female; age 76 years [IQR 69-82]; follow-up 1.86 years [SD 0.4]) were included. During follow-up, 97 (5.7%) experienced a thromboembolic event and 126 (7.4%) experienced MACE. RCS analysis showed significant linear associations between continuous NHHR and primary outcomes (p-overall < 0.001). High NHHR was independently associated with increased risk of thromboembolic events (adjusted Hazard Ratio [aHR] 2.15; 95% CI 1.41-3.29; p < 0.001) and MACE (aHR 1.69; 95% CI 1.15-2.48; p = 0.007), compared to the low NHHR group. No significant associations were observed for secondary outcomes.</p><p><strong>Conclusions: </strong>In anticoagulated AF patients, high NHHR was independently associated with increased residual thromboembolic and cardiovascular risk. NHHR may improve cardiovascular risk stratification in patients with AF, although external validation in more ethnically diverse cohorts is warranted.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"374"},"PeriodicalIF":10.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12486827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}