Cardiovascular Diabetology最新文献

{"title":"Integrating inflammation, insulin resistance, and visceral adiposity: the C-reactive protein-triglyceride-glucose-Chinese visceral adiposity (CTI-CVAI) index is associated with cardiovascular disease risk across CKM stages 0-3 in a nationwide prospective cohort.","authors":"Qian Wang, Jia Li, Hao Qiao, Yuelang Zhang, Ying Xu, Shuqun Zhang, Guihua Zhuang","doi":"10.1186/s12933-026-03248-3","DOIUrl":"10.1186/s12933-026-03248-3","url":null,"abstract":"<p><strong>Background: </strong>Early-stage (0-3) cardiovascular-kidney-metabolic (CKM) syndrome populations require urgent cardiovascular disease (CVD) prevention. Chronic inflammation, insulin resistance, and visceral adiposity are three core interactive CVD pathogenic pathways, while current biomarkers fail to integrate all three. This study aimed to explore the association of the novel three-dimensional composite index CTI-CVAI with incident CVD and its predictive value in Chinese adults with CKM stages 0-3.</p><p><strong>Methods: </strong>This nationwide prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020), including 6728 participants aged ≥ 45 years with CKM stages 0-3. CTI-CVAI was calculated by combining the C-reactive protein-triglyceride-glucose index (CTI) and Chinese visceral adiposity index (CVAI). Cox regression, restricted cubic spline, survival analysis, ROC curves, and reclassification analysis were used to evaluate its value. Subgroup and multiple sensitivity analyses, including competing-risks models, were conducted to assess the robustness of the results.</p><p><strong>Results: </strong>During a median follow-up of 9 years, the overall CVD incidence was 23.83%. CTI-CVAI elevation showed a linear, dose-dependent correlation with increased CVD risk (P < 0.001). After full confounder adjustment, per 1-SD CTI-CVAI increment increased CVD risk by 32% (HR = 1.32, 95% CI 1.26-1.39, P < 0.001), and the highest quartile exhibited 2.07-fold higher risk than the lowest (HR = 2.07, 95% CI 1.77-2.42, P < 0.001). Restricted cubic spline analysis revealed a linear association between CTI-CVAI and incident CVD (P for non-linearity > 0.05). CTI-CVAI demonstrated improved risk reclassification (NRI = 0.0566, P < 0.001) compared with single biomarkers. The association was stable across most subgroups. All sensitivity analyses yielded reliable, robust results.</p><p><strong>Conclusions: </strong>CTI-CVAI is independently and linearly associated with incident CVD risk in Chinese adults with CKM stage 0-3. As a low-cost, accessible biomarker integrating three key pathological pathways, it optimizes early CVD risk stratification and reclassification, providing a promising tool for targeted CVD prevention in CKM high-risk populations.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239035","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":"Apolipoprotein B100 predicts cardiovascular and limb events in type 2 diabetes patients with chronic limb-threatening ischemia.","authors":"Federico Biscetti, Maria Margherita Rando, Maria Anna Nicolazzi, Flavia Angelini, Roberto Iezzi, Luis H Eraso, Paul J Dimuzio, Dario Pitocco, Massimo Massetti, Antonio Gasbarrini, Andrea Flex","doi":"10.1186/s12933-026-03233-w","DOIUrl":"10.1186/s12933-026-03233-w","url":null,"abstract":"<p><strong>Background: </strong>Patients with type 2 diabetes mellitus (T2DM) and chronic limb-threatening ischemia (CLTI) undergoing lower extremity revascularization (LER) face high risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE), despite guideline-directed lipid-lowering therapy. Apolipoprotein B100 (ApoB100), reflecting total atherogenic particle number, may identify residual risk beyond LDL-cholesterol (LDL-C). Therefore, we investigated whether baseline ApoB100 levels independently predict MACE and MALE beyond conventional risk factors in this high-risk population.</p><p><strong>Methods: </strong>In this prospective cohort study, 167 T2DM patients with CLTI undergoing LER were followed for 12 months with visits at 1, 3, 6, and 12 months post-procedure. We measured baseline ApoB100 and assessed its ability to predict MACE, MALE, and composite endpoints, adjusting for clinical covariates.</p><p><strong>Results: </strong>Composite events occurred in 49.1% of patients, MACE in 24%, and MALE in 35.3%. ApoB100 levels were significantly higher in event groups (composite: 62.1 vs 38.0 mg/dL, p < 0.01; MACE: 66.1 vs 44.4 mg/dL, p < 0.01; MALE: 61.0 vs 42.4 mg/dL, p < 0.01). Multivariable analyses confirmed ApoB100 as an independent predictor (composite OR 1.14 per mg/dL, 95% CI 1.08-1.20, p < 0.01; MACE OR 1.10, p < 0.01; MALE OR 1.05, p < 0.01). ROC analysis demonstrated excellent predictive accuracy for ApoB100 (AUC 0.86, 95% CI 0.80-0.91), with optimal ROC-derived cut-off of 56.6 mg/dL. Adding baseline ApoB100 to conventional risk factors significantly improved model discrimination (AUC gains 0.08-0.15, all p < 0.01), while Kaplan-Meier curves by cut-off effectively stratified early events (log-rank p < 0.001).</p><p><strong>Conclusions: </strong>Elevated baseline ApoB100 independently predicted MACE, MALE, and composite events post-LER in T2DM-CLTI patients, substantially improving clinical risk models. Integrating ApoB100 into post-LER management algorithms could refine individualized therapeutic strategies, especially in patients with residual atherogenic risk despite optimal LDL-C control.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238933","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":"Growth differentiation factor-15 and the incidence, bidirectional progression, and risk prediction of atherosclerotic cardiovascular disease and metabolic dysfunction-associated steatotic liver disease in individuals with cardiovascular-kidney-metabolic syndrome stages 0-3.","authors":"Xiaojing Chen, Haoxian Tang, Zhuokai Xu, Xueying Chen, Cuihong Tian, Nan Luo, Jingtao Huang, Hanyuan Lin, Xuan Zhang, Qinglong Yang, Kunyao Liang, Pan Chen, Xianghui Qiu, Liwen Jiang, Wenfeng Lin, Wenqi Chen, Youti Zhang, Xuerui Tan, Jiabao Lai, Yequn Chen","doi":"10.1186/s12933-026-03243-8","DOIUrl":"10.1186/s12933-026-03243-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Growth differentiation factor 15 (GDF-15) is a circulating biomarker reflecting oxidative stress, inflammation, and cellular aging. However, its role in disease risk assessment amongst individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study included 29,697 UK Biobank participants with CKM stages 0-3 defined in accordance with the American Heart Association criteria. Associations of GDF-15 with metabolic, inflammatory and liver fibrosis markers and CKM stage were examined using linear or multinomial logistic regression models. Fine-Gray competing risk regression models were used to evaluate associations with incident atherosclerotic cardiovascular disease (ASCVD), metabolic dysfunction-associated steatotic liver disease (MASLD) and their comorbidity (coexistence of both conditions). Bidirectional disease transitions were assessed using a multi-state Markov model. The relative importance of GDF-15 was evaluated using SHapley Additive exPlanations (SHAP) and likelihood ratio (LR) statistics. Improvements in risk prediction models were assessed using time-dependent area under the receiver operating characteristic curve, Brier score, integrated discrimination improvement and continuous net reclassification improvement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Amongst 29,697 participants (mean age of 56.16 years; 57.32% female), 2,786 developed ASCVD and 456 developed MASLD during follow-up. Higher GDF-15 levels were associated with poorer CKM health and showed the strongest associations with renal function markers, followed by insulin resistance indices. Each 1-unit increase in GDF-15 (normalised protein expression, log2 scale) was associated with increased risks of ASCVD (HR = 1.25, 95%CI 1.15-1.36, P = 1.35 × 10&lt;sup&gt;-7&lt;/sup&gt;), MASLD (HR = 1.62, 95%CI 1.41-1.86, P = 2.06 × 10&lt;sup&gt;-11&lt;/sup&gt;) and their comorbidity (HR = 1.62, 95%CI 1.32-2.18, P = 4.36 × 10&lt;sup&gt;-7&lt;/sup&gt;) after multivariable adjustment for age, sex, smoking status, body mass index, diabetes mellitus, glycated haemoglobin, systolic blood pressure, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, C-reactive protein, creatinine, estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, cystatin C, Townsend deprivation index, physical activity, and CKM stage. These associations remained consistent across subgroup analyses. Multi-state analyses indicated that GDF-15 predicted bidirectional progression between ASCVD and MASLD, with 10-year cumulative incidences of ASCVD and MASLD reaching 15.75% and 2.03%, respectively, among individuals in the top 10% of GDF-15 levels, and further increasing to 20.05% and 2.32% in those in the top 5%. SHAP and LR analyses showed that GDF-15 had high relative importance in predicting ASCVD and MASLD. Incorporating GDF-15 into established risk scores (PREVENT, SCORE2, FLI, FIB-4 and ARPI) showed modest improvements in ","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238904","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":"The effect of empagliflozin on inflammation in patients with overweight or obesity and risk of heart failure: a substudy from the Empire Prevent Metabolic trial.","authors":"Camilla Fuchs Andersen, Julie Hempel Larsen, Massar Omar, Nina Nouhravesh, Caroline Kistorp, Christian Tuxen, Filip K Knop, Julie Lyng Forman, Filip Soeskov Davidovski, Lars Køber, Rugivan Sabaratnam, Kurt Højlund, Morten Schou, Jacob Eifer Møller, Jesper Jensen","doi":"10.1186/s12933-026-03216-x","DOIUrl":"10.1186/s12933-026-03216-x","url":null,"abstract":"<p><strong>Background: </strong>Obesity increases the risk of heart failure (HF), potentially through low-grade inflammatory processes. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have been suggested to attenuate inflammation, although data in patients without diabetes and HF are lacking. Moreover, it is unknown whether SGLT2 inhibitors affect adipose tissue dysfunction. We aimed to investigate the effect of the SGLT2 inhibitor empagliflozin on systemic inflammation, uric acid, and adipose tissue dysfunction in high-risk patients with overweight or obesity.</p><p><strong>Methods: </strong>Pre-defined secondary analysis of the Empire Prevent Metabolic trial. Outpatients with body mass index (BMI) > 28 kg/m² and risk factors for HF, excluding diabetes, were randomised to 180 days treatment with empagliflozin 10 mg or placebo. Patients completed blood sampling and subcutaneous abdominal adipose tissue biopsies at baseline and follow-up. Pre-defined endpoints were the baseline-adjusted estimated treatment differences (ETD) or ratios (ETR) for interleukin-6 (IL-6), high-sensitive C-reactive protein (hsCRP), and uric acid. Furthermore, we explored gene expression changes in selected markers of adipose tissue dysfunction, including inflammation.</p><p><strong>Results: </strong>We randomised 92 patients (empagliflozin: 44, placebo: 48). Median age was 68 years, median BMI was 31.6 kg/m², while 21 (23%) and 54 (59%) patients presented with IL-6 > 7 pg/ml and hsCRP of at least 3 mg/l, respectively. Empagliflozin did not affect IL-6 (ETR: 1.03, 95% CI 0.82-1.30, p = 0.78) or hsCRP (ETR: 1.15, 95% CI 0.87-1.51, p = 0.33) compared to placebo. Meanwhile, uric acid decreased (ETD: - 0.06 mmol/l, 95% CI - 0.08 to - 0.04, p < 0.0001), whereas no changes in adipose tissue gene expression were observed.</p><p><strong>Conclusions: </strong>In this study, empagliflozin did not demonstrate anti-inflammatory effects but yielded possibly meaningful uricosuric effects in non-diabetic patients with overweight or obesity. Moreover, adipose tissue dysfunction remained unaltered. Trial registration clinicaltrials.gov NCT05042973.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238751","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 metabolic score for insulin resistance and new-onset stroke in middle-aged and older adults: a national cohort study.","authors":"Xuexue Zhang, Rui Wei, Huanrong Hu, Xujie Wang, Qiuyan Li","doi":"10.1186/s12933-026-03232-x","DOIUrl":"10.1186/s12933-026-03232-x","url":null,"abstract":"<p><strong>Background: </strong>Metabolic score for insulin resistance (METS-IR) is acknowledged as a reliable indicator of insulin resistance and cardiometabolic risk. This study aims to explore the relationship between cumulative METS-IR (cumMETS-IR) and METS-IR change patterns with new-onset stroke.</p><p><strong>Methods: </strong>4344 participants from the China Health and Retirement Longitudinal Study (CHARLS) with follow-up until 2020 were utilized in this study. cumMETS-IR was calculated as the area under the curve of METS-IR values from 2011 to 2015. K-means clustering analysis was employed to discern distinct METS-IR change patterns over this interval. Associations of cumMETS-IR and METS-IR change patterns with incident stroke were examined using Cox proportional hazards models and restricted cubic splines (RCS). Mediation analysis assessed whether diastolic blood pressure (DBP) accounted for the association between cumMETS-IR and incident stroke.</p><p><strong>Results: </strong>There were 385 (8.86%) new stroke events over 5-years median follow-up. RCS analysis showed that cumMETS-IR was positively correlated with incident stroke (P-overall = 0.013, P-nonlinear = 0.252). Compared with the lowest quartile, the highest quartile was associated with a higher incidence of stroke (adjusted hazard ratio [HR] 1.72, 95% confidence interval [CI] 1.22-2.42, P = 0.002). Four distinct METS-IR change patterns were identified using k-means clustering: low-stable (30.5%), low-to-moderate stable (35.9%), moderate-to-high stable (24.7%), and high-decreasing (8.9%). Participants following the high-decreasing pattern was associated with the highest incidence of stroke compared to those in the low-stable patterns (adjusted HR 1.61, 95% CI 1.08-2.42, P = 0.021). The core findings remained robust across a series of sensitivity analyses. Mediation analysis revealed that DBP partially explained this association, with a mediation proportion of 9.6%.</p><p><strong>Conclusion: </strong>Both cumMETS-IR and METS-IR change were associated with increased incidence of stroke in middle-aged and older Chinese adults. Monitoring changes in METS-IR over time may help characterize metabolic status more comprehensively and offer supportive information for stroke-related health assessment.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223470","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":"Estimated glucose disposal rate outperforms inflammation surrogate markers in predicting cardiometabolic multimorbidity among middle-aged and older adults.","authors":"Cancan Cui, Xu Wang, Liqiang Wang, Kaiming Xue, Jinghui Cao, Lingyu Zhang, Siqi Yue, Shengtong Chen, Lin Liu, Yanxi Liu, Jianshi Du","doi":"10.1186/s12933-026-03249-2","DOIUrl":"10.1186/s12933-026-03249-2","url":null,"abstract":"<p><strong>Background: </strong>Both estimated glucose disposal rate (eGDR) and inflammation surrogate (high-sensitivity C-reactive protein [hs-CRP]) have emerged as potential markers reflecting metabolic health. However, their comparative predictive value for cardiometabolic multimorbidity remains unclear, particularly in middled-aged and older populations where both metabolic dysfunction and low-grade inflammation are highly prevalent.</p><p><strong>Methods: </strong>This prospective cohort study included 7,589 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS) with complete baseline data. The primary outcome was incident cardiometabolic multimorbidity, defined as the co-occurrence of two or more cardiometabolic conditions, including diabetes, heart disease, and stroke. Cox proportional hazards models were employed to assess separate and joint associations. Concordance index (C-index) was used to evaluate the predictive capacity.</p><p><strong>Results: </strong>Over a 9-year follow-up period, 2,263 participants developed cardiometabolic multimorbidity. In models adjusting for traditional risk factors, lower eGDR (lowest vs. highest quartile: hazard ratio [HR] 2.07, 95% CI 1.80-2.38) remained significantly associated with increased risk of cardiometabolic multimorbidity. In joint associations, participants with low eGDR exhibited consistently elevated cardiometabolic multimorbidity risk regardless of inflammation surrogate status (HR 1.52 (95% CI 1.33-1.74) in those with low inflammation and HR 1.80 (95% CI 1.58-2.04) in those with high inflammation). Addition of eGDR to the basic model (which included covariates) yielded a significantly higher C-index (0.676) compared to hs-CRP (0.643, P < 0.001).</p><p><strong>Conclusions: </strong>Among middle-aged and older adults, eGDR is significantly associated with incident cardiometabolic multimorbidity regardless of inflammation status. Low eGDR demonstrates superior discriminative ability compared to hs-CRP. These findings suggest that eGDR may serve as a more comprehensive biomarker for cardiometabolic risk stratification by capturing insulin resistance and metabolic dysfunction.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13483815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223442","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":"Predicting subclinical atherosclerosis in adults with type 1 diabetes using cardiovascular risk models: a cross‑sectional study from Italy.","authors":"Chiara Molinari, Arianna Galotta, Saima Mushtaq, Beatrice Frigerio, Chiara Vavassori, Maurizio Rondinelli, Nicola Cosentino, Alessandra Romandini, Mattia Chiesa, Maria Cristina Vinci, Gualtiero Ivanoe Colombo, Damiano Baldassarre, Gianluca Pontone, Alice Bonomi, Stefano Genovese","doi":"10.1186/s12933-026-03245-6","DOIUrl":"10.1186/s12933-026-03245-6","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among individuals with type 1 diabetes (T1D); nevertheless, cardiovascular risk stratification remains an unmet need in T1D. Cardiovascular risk tools were developed to predict 10‑year clinical events. Whether they identify subclinical atherosclerosis - a potential gatekeeper for intensified prevention - remains uncertain.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of consecutive T1D adults without a history of CVD enrolled at a secondary centre in Italy. All participants underwent coronary computed tomography angiography (CCTA) and carotid ultrasound. The primary outcome was a composite imaging endpoint, defined as any coronary plaque on CCTA and/or maximum carotid intima-media thickness (cIMT_max) ≥ 1.5 mm. We compared the performance of T1D-specific CV risk models (2019 European Society of Cardiology [ESC] Guidelines, Steno Type 1 Risk Engine [ST1RE], and Scottish-Swedish CVD risk prediction tool) in predicting the presence of subclinical atherosclerosis. Discrimination was assessed using the Area Under the receiver operating characteristic Curve (AUC), and differences between AUCs were evaluated using the DeLong test; calibration was visualised with calibration plots and summarised by Brier score. Sensitivity analyses evaluated CCTA‑only and carotid‑only endpoints.</p><p><strong>Results: </strong>One hundred and one patients (52.5% males) were included in the study, with a mean age of 45 ± 13 years and a median diabetes duration of 21 years (Q1-Q3 13; 32). The composite imaging endpoint occurred in 66/101 (65.4%); 55 patients (54.5%) had coronary plaques, and 41 patients (40.6%) presented cIMT_max above threshold. Both ST1RE and the Scottish-Swedish risk scores showed strong discrimination for the combined imaging endpoint (AUC 0.899 and 0.907, respectively). Apparent calibration to the imaging endpoint was acceptable, with Brier scores of 0.126 for ST1RE and 0.128 for the Scottish-Swedish model.</p><p><strong>Conclusions: </strong>In an Italian cohort of asymptomatic T1D adults, T1D-specific risk scores demonstrated a strong discrimination ability for imaging-defined subclinical atherosclerosis. They might help triage asymptomatic individuals who could benefit from targeted cardiovascular imaging in specific settings. Since these tools predict events rather than imaging findings, recalibration and prospective validation against imaging endpoints are needed before using predicted probabilities as absolute risks informing clinical decision‑making.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06290544. Registered on 4 March 2024.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223232","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":"Association of the C-reactive protein-triglyceride-glucose (CTI) index and its central obesity-modified derivatives with incident cardiometabolic multimorbidity: results from two prospective cohorts in China and England.","authors":"Chuhui Yue, Xinyu Wang, Yaona Li, Sujun Yuan, Zhu Wang, Hongli Liu, Huiyu Yang","doi":"10.1186/s12933-026-03238-5","DOIUrl":"10.1186/s12933-026-03238-5","url":null,"abstract":"<p><strong>Background: </strong>Central obesity exacerbates cardiometabolic multimorbidity (CMM) susceptibility through insulin resistance and inflammation. We investigated the longitudinal association of C-reactive protein-triglyceride-glucose (CTI)-related indices-which integrate these mechanisms with abdominal obesity measurements-with incident CMM in middle-aged and older adults.</p><p><strong>Methods: </strong>This study included 6,498 participants from the China Health and Retirement Longitudinal Study and 2,455 from the English Longitudinal Study of Ageing, all free of diabetes, heart disease, and stroke at baseline. Incident CMM was defined as the occurrence of at least two of these diseases during follow-up. CTI-waist circumference (CTI-WC) and CTI-waist-to-height ratio (CTI-WHtR) were prespecified as principal exposures, with CTI, triglyceride-glucose index (TyG), and corresponding obesity-related derivatives as comparators. Death before CMM was treated as a competing event. Associations and prediction were assessed using Fine-Gray models, cumulative incidence functions, restricted cubic splines, time-dependent area under the curve, C-statistic, net reclassification improvement, integrated discrimination improvement, and calibration metrics.</p><p><strong>Results: </strong>During median follow-up periods of 7.00 and 9.58 years, 303 and 255 participants developed incident CMM in the Chinese and English cohorts, respectively. In the Chinese cohort, each 1-standard deviation increase in CTI-WC and CTI-WHtR was associated with higher CMM risk (CTI-WC: subdistribution HR = 1.59, 95% CI 1.44-1.75; CTI-WHtR: subdistribution HR = 1.59, 95% CI 1.44-1.76), and the highest quartile had approximately fourfold higher risk than the lowest quartile. In the English cohort, associations were weaker but directionally consistent, with CTI-WC remaining significant per 1-standard deviation increment (1.18, 1.03-1.35). In the Chinese cohort, CTI-WC and CTI-WHtR yielded the highest 7-year area under the curve values (0.693 and 0.692), and CTI-WC showed the largest reclassification improvement. Calibration and sensitivity analyses supported model stability.</p><p><strong>Conclusions: </strong>Prespecified CTI-WC and CTI-WHtR were associated with incident CMM after accounting for competing mortality. Integrating inflammatory-metabolic burden with central adiposity may improve CMM risk stratification, especially in the Chinese cohort.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216509","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":"Increased epicardial adipose tissue area and radiodensity in sarcopenic obesity.","authors":"Tianwen He, Ruilin Wang, Wenhua Jiang, Rongna Lian, Xiaomei Chen, Ming Yang","doi":"10.1186/s12933-026-03237-6","DOIUrl":"10.1186/s12933-026-03237-6","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenic obesity (SO) confers substantially greater cardiometabolic risk than either sarcopenia or obesity alone, but the tissue-level structural alterations underlying this risk remain unclear. Epicardial adipose tissue (EAT) characteristics, including both area and radiodensity, may provide clinically relevant insight into the cardiometabolic burden associated with this complex muscle-fat imbalance.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of 1678 adults undergoing health examinations. Participants were categorized into normal, sarcopenia, obesity, and SO phenotypes based on the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity (ESPEN/EASO) conceptual framework. Body composition and grip strength were assessed according to the Asian Working Group for Sarcopenia (AWGS) 2025 criteria. EAT area (cm²) and radiodensity (attenuation, measured in Hounsfield units [HU]) were quantified via non-contrast chest computed tomography. Associations were assessed using multivariable linear regression, interaction analysis, and sex-stratified restricted cubic splines.</p><p><strong>Results: </strong>The SO phenotype was identified in 45 individuals. Following multivariable adjustment, SO was independently associated with a larger EAT area (beta = 6.93 cm²; 95% CI, 5.84 to 8.03) and a higher (less negative) EAT radiodensity (beta = 9.23 HU; 95% CI, 8.03 to 10.43) compared with the normal phenotype. Effect estimates were larger for SO than for isolated obesity. An interaction between sarcopenia and obesity was observed for EAT area (interaction beta = 1.53 cm²; 95% CI, 0.05 to 3.01; P for interaction = 0.042), whereas no significant interaction was observed for EAT radiodensity. In sex-stratified analyses, grip strength showed a pronounced non-linear association with EAT radiodensity.</p><p><strong>Conclusions: </strong>In this cross-sectional study, SO was associated with larger EAT area and higher EAT radiodensity. These findings support the presence of a distinct EAT phenotype in SO and suggest that CT-derived EAT measures may be useful imaging markers that warrant prospective validation.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216489","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":"Differential associations between novel triglyceride-glucose-obesity indices and incident stroke in individuals with early-stage cardiovascular-kidney-metabolic syndrome: a longitudinal cohort study.","authors":"Zhi-Qing Fu, Li An, Wei Zhang, Yue Lyu, Shan Li","doi":"10.1186/s12933-026-03240-x","DOIUrl":"10.1186/s12933-026-03240-x","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index combined with advanced anthropometric measures has emerged as a promising tool for cardiovascular risk assessment. However, evidence comparing the predictive utility of various novel TyG-obesity indices for incident stroke in individuals with early-stage cardiovascular-kidney-metabolic (CKM) syndrome remains limited. This study aimed to investigate and compare the associations of six novel TyG-obesity indices (TyG-Chinese visceral adiposity index [CVAI], -body roundness index [BRI], -conicity index [CI], -weight-adjusted waist index [WWI], -a body shape index [ABSI], and -relative fat mass [RFM]) with stroke in individuals with CKM stages 0-3.</p><p><strong>Methods: </strong>This prospective cohort study included 3400 participants from the China Health and Retirement Longitudinal Study. K-means clustering was used to identify longitudinal change patterns, and the Boruta algorithm ranked feature importance. We used Cox proportional hazards models to evaluate the strength of associations, restricted cubic splines (RCS) to explore dose-response relationships, receiver operating characteristic (ROC) curves to assess discriminative ability, and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) to quantify incremental predictive performance.</p><p><strong>Results: </strong>During a median follow-up of 8.6 years, 232 incident strokes were documented. Using a multidimensional analytical framework incorporating baseline, cumulative, and longitudinal change-based approaches, six indices were differentially associated with stroke risk, with TyG-CVAI and TyG-BRI showing stronger and more consistent associations. Each standard deviation increase in baseline TyG-CVAI and TyG-BRI corresponded to hazard ratios (HRs) of 1.36 (95% CI 1.17-1.57) and 1.32 (1.14-1.53). The corresponding cumulative HRs were 1.31 (1.14-1.52) and 1.29 (1.11-1.49). Compared with the stable low-level group, sustained high-level group yielded HRs of 2.28 (1.54-3.39) for TyG-CVAI and 2.01 (1.35-2.99) for TyG-BRI. Stage-specific analyses revealed stronger associations in CKM stage 2. Both indices demonstrated positive linear dose-response relationships. ROC analyses showed that TyG-CVAI and TyG-BRI had relatively better discrimination, and NRI/IDI analyses demonstrated incremental predictive value over the baseline model.</p><p><strong>Conclusion: </strong>Among the six novel TyG-obesity indices evaluated, TyG-CVAI and TyG-BRI emerged as stronger predictors of incident stroke in individuals with early-stage CKM syndrome, particularly in stage 2. These findings highlight the potential utility of these two indices for stroke risk stratification and may inform early detection strategies in this vulnerable population.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204226","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}