Cardiovascular Diabetology最新文献

{"title":"Association between atherogenic index of plasma (AIP) and all-cause and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD): a cohort study based on NHANES 1999-2018.","authors":"Meiping Gan, Bo Chen, Minghui Qin, Ling Zhang, Xiaolin Wang","doi":"10.1186/s12933-025-02941-z","DOIUrl":"10.1186/s12933-025-02941-z","url":null,"abstract":"<p><strong>Background: </strong>Lipid metabolism plays a pivotal role in the pathogenesis of metabolic dysfunction-associated fatty liver disease (MASLD). However, the effect of the atherogenic index of plasma (AIP)-a novel biomarker for assessing lipid metabolic abnormalities and atherosclerosis risk-on MASLD-related mortality remains unclear.</p><p><strong>Methods: </strong>This study included 6,567 patients with MASLD from the National Health and Nutrition Examination Survey (1999-2018), with mortality data linked to National Death Index records through 31 December 2019. Participants were categorised into quartiles based on AIP. The association between baseline AIP and all-cause mortality (ACM) or cardiovascular disease mortality (CVM) were investigated using multivariate Cox Models, with restricted cubic spline (RCS) curves evaluated to assess potential nonlinear associations. Subgroup and mediation analyses explored modifiers and mediator (HbA1c, neutrophils, hypertension), while sensitivity analyses tested the robustness .</p><p><strong>Results: </strong>During a median follow-up period of 122 months, 1,323 all-cause and 447 CVD-related deaths occurred. After adjusting for confounders, higher AIP was significantly associated with an increased CVM risk (HR = 1.34, 95% CI = 1.01-1.79, P = 0.05). No significant association was observed between AIP and ACM (HR = 1.05, 95% CI = 0.89-1.24, P = 0.50). RCS analysis revealed a J-shaped relationship between AIP and ACM (threshold = 1.71), with a significant increase in ACM risk when AIP > 1.71 (HR = 1.48, 95% CI = 1.14-1.92, P = 0.003). Subgroup analyses showed a significant interaction between AIP and age (P_{for_interaction} = 0.018); among individuals < 60 years, elevated AIP significantly increased ACM (HR = 1.25; 95% CI = 1.04-1.51; P = 0.018). Mediation analysis revealed that HbA1c mediated 73.17% of the total effect of AIP on ACM and 42.98% of the effect on CVM. Neutrophils accounted for 20.10% and 12.48%, respectively, whereas hypertension mediated 9.80% and 11.96%, respectively. Sensitivity analysis confirmed their robustness.</p><p><strong>Conclusions: </strong>In US patients with MASLD, baseline AIP exhibited a J-shaped relationship with ACM. An AIP > 1.71 may warrant early intervention. Baseline AIP may be an effective predictor of future ACM and CVM in individuals aged < 60. However, further research is required to validate these findings.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"391"},"PeriodicalIF":10.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12512302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273985","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":"Cardiometabolic HFpEF with focus on type 2 diabetes mellitus.","authors":"Era Gorica, Francesco Paneni","doi":"10.1186/s12933-025-02955-7","DOIUrl":"10.1186/s12933-025-02955-7","url":null,"abstract":"","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"390"},"PeriodicalIF":10.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257520","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 epicardial fat volume index with coronary artery disease phenotypes based on anatomical and functional imaging: a linkage with the severity of coronary artery disease.","authors":"Chunbo Wang, Wenji Yu, Xiaoyu Yang, Fan Sun, Yu Tian, Yue Yue, Feifei Zhang, Xiaoliang Shao, Yunmei Shi, Bao Liu, Jianfeng Wang, Sijin Li, Yuetao Wang","doi":"10.1186/s12933-025-02897-0","DOIUrl":"10.1186/s12933-025-02897-0","url":null,"abstract":"<p><strong>Background: </strong>Epicardial adipose tissue (EAT) plays an important role in the pathogenesis of coronary artery disease (CAD). The association between EAT and obstructive CAD or myocardial ischemia has been established, but its relationship with CAD phenotypes based on anatomical and functional imaging remains unclear.</p><p><strong>Methods: </strong>A total of 495 suspected CAD patients who underwent both single-photon emission computed tomography/computed tomography myocardial perfusion imaging (SPECT/CT MPI) and coronary angiography (CAG/CTA) were enrolled in this retrospective study. Epicardial fat volume (EFV) and epicardial fat volume indexed to body surface (EFVi) were measured on non-contrast CT. CAD phenotypes were categorized into 4 groups based on the presence or absence of obstructive CAD (any epicardial coronary diameter stenosis ≥ 50% by CAG/CTA) and myocardial ischemia (diagnosed by MPI): Group1 (non-obstructive CAD without ischemia, n = 165), Group2 (ischemia with non-obstructive CAD, INOCA, n = 69), Group3 (obstructive CAD without ischemia, n = 149), Group4 (obstructive CAD with ischemia, n = 112).</p><p><strong>Results: </strong>Both EFV and EFVi had an increasing trend across 4 groups [EFVi: median (interquartile range), cm³/m²: 80.54 (68.10-102.37) vs. 84.44 (73.57-100.93) vs. 89.63 (75.39-103.15) vs. 91.67 (76.48-111.66), p = 0.007, p for trend < 0.001]. In adjusted ordered logistic regression model, EFVi was independently associated with more advanced CAD phenotype levels (per SD unit change: OR = 1.26, 95% CI:1.03-1.55, p = 0.024). Subgroup analysis showed diabetes subgroup had the strongest correlation between EFVi and CAD phenotype levels in ordered logistic regression model (OR = 3.45, 95%CI:1.52-7.82, p = 0.003). In adjusted unordered multinomial logistic regression model, with Group1 as reference group, maximizing Youden index method was used to find the optimal cutoff values for EFV/EFVi on Group2 to Group4. Both EFV and EFVi were independently associated with Group3 and Group4 but only EFVi was independently associated with INOCA (EFV: EFV >134.47cm³ for INOCA, OR = 1.94, 95%CI:0.97-3.88, p = 0.058, EFVi: EFVi >80.67cm³/m² for INOCA, OR = 2.53, 95%CI:1.25-5.12, p = 0.010). Net reclassification improvement (NRI) showed that EFVi was more effective than EFV in diabetes subgroup to differentiate CAD phenotypes over traditional cardiovascular risk factors.</p><p><strong>Conclusion: </strong>EFVi was correlated with the severity of CAD phenotype levels based on anatomical and functional imaging. EFVi had the strongest correlation with CAD phenotypes levels in diabetes subgroup. Notably, EFVi rather than EFV exhibits a distinct linkage with INOCA. EFVi was more effective to provide incremental value of differentiating CAD phenotypes over traditional cardiovascular risk factors than EFV in diabetes subgroup.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"387"},"PeriodicalIF":10.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249781","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":"Deep learning-based coronary calcium score derived from non-gated chest CT and major adverse cardiovascular events in patients with type 2 diabetes mellitus.","authors":"Yidan Xu, Yarong Yu, Xiaoying Ding, Jiajun Yuan, Lihua Yu, Xu Dai, Runjianya Ling, Yufan Wang, Jiayin Zhang","doi":"10.1186/s12933-025-02934-y","DOIUrl":"10.1186/s12933-025-02934-y","url":null,"abstract":"<p><strong>Background: </strong>Deep learning (DL) models can quantify coronary artery calcification using non-gated chest CT scans. However, the prognostic value of a DL-based coronary artery calcium score (DL-CACS) for predicting major adverse cardiovascular events (MACEs) in patients with type 2 diabetes mellitus (T2DM) remains unclear.</p><p><strong>Objectives: </strong>This study aimed to evaluate the prognostic value of DL-CACS derived from non-gated chest CT scans in patients with T2DM and to develop a risk stratification model for predicting MACEs.</p><p><strong>Methods: </strong>Patients with T2DM who underwent non-gated chest CT scans were retrospectively included and followed up for at least 2 years. Patients from Hospital A were randomly assigned to a training cohort and an internal validation cohort in a 3:2 ratio. Two predictive models were developed in the training cohort: Model 1 used the Framingham risk score (FRS), and Model 2 incorporated FRS and DL-CACS. The external validation cohort from Hospital B and the internal validation cohort were used to validate the proposed model.</p><p><strong>Results: </strong>A total of 2,241 patients with T2DM (median age, 61 years; range, 54-68 years; 1,257 males) were included in this study. MACEs occurred in 10.71% (240/2241) of patients during follow-up. Patients who experienced MACEs exhibited significantly higher DL-CACS values than those without MACEs (p < 0.001). In the training cohort, multivariate Cox regression analysis identified DL-CACS as an independent predictor of MACEs (hazard ratio [HR], 1.07; p < 0.001). Moreover, Model 2 demonstrated superior predictive performance compared to Model 1 across the training, internal validation, and external validation cohorts. In the external validation cohort, the C-index of Model 2 was larger than that of Model 1 (C-Index, 0.70 [0.63-0.77] vs. 0.67 [0.61-0.74]; p = 0.007).</p><p><strong>Conclusion: </strong>DL-CACS derived from non-gated chest CT is an independent predictor of MACEs and provides incremental value in risk stratification for patients with T2DM compared with the FRS.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"389"},"PeriodicalIF":10.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249788","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":"Plasma ALKAL2 levels are associated with coronary atherosclerosis in patients with type 2 diabetes mellitus.","authors":"Yipaerguli Maimaiti, Minhui Wang, Shuai Chen, Feifei Li, Jingmeng Liu, Xinrui Wu, Jianjun Chen, Qiujing Chen, Weifeng Shen, Fenghua Ding, Yang Dai, Lin Lu","doi":"10.1186/s12933-025-02948-6","DOIUrl":"10.1186/s12933-025-02948-6","url":null,"abstract":"<p><strong>Background: </strong>Cancer-associated signaling pathways, particularly the ALK/LTK receptor tyrosine kinases and their ligand ALKAL2, have recently been implicated in chronic inflammation and myocardial remodeling. However, the relationship between ALKAL2 and coronary artery disease (CAD) pathogenesis in type 2 diabetes mellitus (T2DM) remains undefined.</p><p><strong>Methods: </strong>From January 2019 to December 2020, patients with type 2 diabetes mellitus (T2DM) undergoing coronary angiography were consecutively enrolled at Ruijin Hospital. Plasma ALKAL2 levels were measured using an ELISA assay. The association between ALKAL2 and CAD severity was assessed by Spearman correlation analysis. Logistic regression models were used to measure the association between ALKAL2 and CAD risk.</p><p><strong>Results: </strong>275 T2DM patients with CAD and 275 age- and sex-matched T2DM patients without CAD were included in the final analysis. Plasma ALKAL2 levels were increased in T2DM patients with CAD (0.25 [0.21, 0.37] ng/mL, median [IQR] vs. 0.18 [0.14, 0.24]ng/mL) (p < 0.001) and were positively associated with CAD severity (Spearman rho = 0.53, p < 0.001). Multivariate analysis revealed that plasma ALKAL2 levels were independently associated with the incidence of CAD after adjusting for LDL-C, hsCRP, and other traditional risk factors (OR, 2.24 [95% CI, 1.79-2.85]; p < 0.001).</p><p><strong>Conclusions: </strong>Elevated plasma ALKAL2 levels are an independent risk factor for T2DM CAD and are associated with the severity of CAD.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"388"},"PeriodicalIF":10.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249728","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":"Real-world cardiovascular effectiveness of sustained glucagon-like peptide 1 GLP-1 receptor agonist usage in type 2 diabetes.","authors":"Kathrine Kold Sørensen, Puriya Daniel Würtz Yazdanfard, Bochra Zareini, Ulrik Pedersen-Bjergaard, Vanja Kosjerina, Mikkel Porsborg Andersen, Anders Munch, Johan Sebastian Ohlendorff, Stefanie Schmid, Stefanie Lanzinger, Pratik Choudhary, Clare Gillies, Safoora Gharibzadeh, Marcus Lind, Viktor Tasselius, Jens Michelsen, Thomas Alexander Gerds, Christian Torp-Pedersen","doi":"10.1186/s12933-025-02915-1","DOIUrl":"10.1186/s12933-025-02915-1","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular outcome trials have shown that glucagon-like peptide 1 receptor agonists (GLP1-RAs) reduce cardiovascular event rates more effectively than placebo and in patients with type 2 diabetes at increased cardiovascular risk. However, the generalizability of these findings to real-world settings remains uncertain.</p><p><strong>Aim: </strong>This study aimed to evaluate the real-world cardiovascular effectiveness of sustained GLP1-RA use compared to dipeptidyl peptidase 4 inhibitor (DPP-4i) over 3.5 years.</p><p><strong>Methods: </strong>Using Danish nationwide registries, we emulated a target trial to assess the real-world effectiveness of GLP1-RAs in a population of individuals with type 2 diabetes mirroring the inclusion and exclusion criteria from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial. The study period was 2012-2022. Outcomes included the composite of myocardial infarction, stroke, and cardiovascular mortality (3P-MACE), as well as each component individually, alongside all-cause mortality, heart failure, angina pectoris, and revascularization. Longitudinal Targeted Minimum Loss-based Estimation, a method that adjusts for both baseline and time-varying confounding, was used to estimate absolute risks of cardiovascular outcomes under sustained use of GLP1-RA and DPP 4i (active comparator), adjusting for baseline and time-varying confounding.</p><p><strong>Results: </strong>We included 6,681 people initiating GLP1-RA and 19,072 initiating DPP-4i. Accounting for baseline and time-varying confounding, sustained GLP1-RA use showed a 2.5% (95% CI 0.8-4.1%) risk reduction of 3P-MACEover 3.5 years. Risk reductions for cardiovascular mortality, all-cause mortality, heart failure, and unstable angina pectoris were 2.3% (95% CI 1.4-3.1%), 2.5% (95% CI 0.7-4.3%), 0.9% (95% CI 0.01-1.8%), and 0.7% (95% CI 0.01-1.3%), respectively. No significant differences were observed for myocardial infarction, stroke, or revascularization with risk differences of 0.1% (95% CI -1.0 to 0.8%), 0.8% (95% CI -0.2 to 1.7%), and 0.2% (95% CI -0.7-1.1%), respectively.</p><p><strong>Conclusions: </strong>This real-world study confirms the cardiovascular benefits of GLP1-RAs over DPP-4is, particularly for reducing cardiovascular and all-cause mortality under continuous treatment exposure in patients with type 2 diabetes at increased cardiovascular risk.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"385"},"PeriodicalIF":10.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237995","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 cumulative exposure and dynamic trajectories of the C-reactive protein-triglyceride-glucose index with incident stroke in middle-aged and older Chinese adults: a longitudinal analysis based on CHARLS.","authors":"Yibo Yang, Aihua Liu","doi":"10.1186/s12933-025-02945-9","DOIUrl":"10.1186/s12933-025-02945-9","url":null,"abstract":"<p><strong>Background: </strong>The C-Reactive Protein-Triglyceride-Glucose Index (CTI) has been proposed as a novel biomarker for insulin resistance and inflammation. However, research on the relationship between CTI changes and stroke is limited. This study aims to investigate the association between changes in CTI and stroke risk.</p><p><strong>Methods: </strong>Participants were drawn from the China Health and Retirement Longitudinal Study (CHARLS). Stroke was defined as self-reported stroke. K-means clustering analysis was used to classify CTI changes, and cumulative CTI (cuCTI) was calculated as follows: (CTI₂₀₁₂ + CTI₂₀₁₅)/2 × time. To assess the association between CTI and stroke risk, Cox regression and restricted cubic spline (RCS) regression models were applied.</p><p><strong>Results: </strong>A total of 4,364 participants were included in the study, among whom 323 (7.4%) experienced a stroke. The risk of stroke increased with higher levels of cuCTI. In the multivariable-adjusted model, Cox regression analysis showed that, compared with the lowest quartile (Q1), participants in the highest quartile (Q4) had a significantly increased risk of stroke by 103% (HR = 1.90, 95% CI: 1.30-2.78, P < 0.001). Furthermore, stroke risk increased progressively across ascending cuCTI quartiles (P for trend < 0.001). RCS analysis demonstrated a linear association between cuCTI and stroke risk (for nonlinearity, p < 0.001). K-means clustering identified three distinct trajectories of CTI variation. Participants with moderate and elevated CTI levels (HR = 1.53, 95% CI: 1.17-2.00, P = 0.001) and those with high CTI levels showing a slow increasing trend (HR = 1.75, 95% CI: 1.25-2.48, P < 0.001) had a significantly higher risk of stroke.</p><p><strong>Conclusion: </strong>This study demonstrates that both cuCTI and CTI changes are associated with stroke risk in middle-aged and older adults, particularly for those with consistently high CTI levels, which are linked to a significantly increased stroke risk. Monitoring long-term CTI changes and maintaining relatively low levels may help prevent stroke in this population.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"386"},"PeriodicalIF":10.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237942","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":"Dual modulation of lipid and glucose metabolism by a nutraceutical combination in patients at cardiometabolic risk: results from a multicenter randomized controlled trial.","authors":"Daniela Pacella, Maria Lembo, Valentina Trimarco, Alessia Izzo, Maria Virginia Manzi, Stanislovas S Jankauskas, Imma Forzano, Paola Gallo, Alessandra Spinelli, Carmine Morisco, Stefano Cristiano, Paola Ida Rozza, Eliana Esposito, Felicia Rozza, Lorena Esposito, Sun King B Bear, Giuseppe Giugliano, Gaetano Santulli","doi":"10.1186/s12933-025-02920-4","DOIUrl":"10.1186/s12933-025-02920-4","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), a key enzyme in cholesterol biosynthesis, has beneficial effects on lipid metabolism and blood pressure (BP), but detrimental consequences on glycemia. Nutraceuticals (NUTs) containing both Monacolin K (MK) and Morus alba have been shown to be more effective in lowering lipids compared to NUT formulations containing only MK. However, the effects of these NUTs on glucose homeostasis have not been fully determined.</p><p><strong>Methods: </strong>To evaluate the association between LDL-C-lowering therapy and glycemia in patients receiving NUT combinations with or without Morus alba, we analyzed data from a prospective, randomized, active-treatment controlled trial (NCT02898805), which enrolled 359 patients to compare the effects of a NUT combination containing MK alone (Formulation 1, F1; n = 170) versus one containing MK and Morus alba (Formulation 1, F2; n = 189).</p><p><strong>Results: </strong>Participants in the two treatment arms (F1 vs. F2) were comparable in terms of sex, age, metabolic parameters, and BP. After 3 months, both groups experienced significant reductions in LDL-C, fasting plasma glucose, HbA1c, and HOMA index. F2 treatment led to a significantly greater reduction in glycemic levels compared to F1 treatment (b = - 16, p < 0.001). Notably, a divergent trend emerged over time: an inverse relationship between LDL-C and glycemic levels was observed in the F1 group, while a significant direct association between LDL-C and glycemic levels was detected in the F2 group (b = 0.06, p = 0.002).</p><p><strong>Conclusions: </strong>Taken together, our findings indicate that the treatment with a NUT combination containing Morus alba simultaneously reduces plasma levels of LDL-C and glucose.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"384"},"PeriodicalIF":10.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225157","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":"Development and evaluation of a machine learning prediction model for short-term mortality in patients with diabetes or hyperglycemia at emergency department admission.","authors":"Per Wändell, Marcelina Wierzbicka, Karolina Sigurdsson, Anna Olofsson, Caroline Wachtler, Torgny Wessman, Olle Melander, Ulf Ekelund, Anders Björkelund, Axel C Carlsson, Toralph Ruge","doi":"10.1186/s12933-025-02954-8","DOIUrl":"10.1186/s12933-025-02954-8","url":null,"abstract":"<p><strong>Background: </strong>Patients with diabetes admitted to emergency care face a higher risk of complications, including prolonged hospital stays, admissions to the intensive care unit and mortality.</p><p><strong>Aim: </strong>To develop a machine learning (ML) model to predict 30-day mortality in patients with diabetes admitted to the emergency department (ED).</p><p><strong>Design and setting: </strong>A cohort study utilizing data from all nine ED's in Region Skåne 2017 to 2018. Totally 74,611 patient visits, representing 34,280 unique patients aged > 18 years with diabetes or hyperglycemia (glucose were > 11 mmol/L). The analysis focused on four groups, men and women aged 40-69 and ≥ 70 years.</p><p><strong>Methods: </strong>Stochastic gradient boosting was employed to develop a model predicting 30-day mortality. Variable importance was assessed using normalized relative influence (NRI) scores. Variables in certain hospitals were used to train the models, and the models were tested in other hospitals.</p><p><strong>Results: </strong>Key predictors included laboratory values (pH, base excess, pCO₂, standard bicarbonate, oxygen saturation, lactate, CRP, and leukocytes), as well as age, triage category, and time to doctor consultation. The sensitivity of the models ranged from 86-97%, the specificity from 86-94%, and accuracy between 86% and 94%. The area under the curve (AUC) ranged from 0.84 to 0.93 and Cohen's kappa ranged from 0.34 to 0.45. Positive predictive values accurately identified mortality in 23% to 37% of cases across the four groups.</p><p><strong>Conclusions: </strong>A machine learning model based on routinely collected data in the ED accurately predicted 30-day mortality with high specificity and sensitivity. This approach shows promise in identifying high-risk patients requiring close monitoring and timely interventions.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"383"},"PeriodicalIF":10.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225055","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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492775/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}