Cardiovascular Diabetology最新文献

{"title":"Oxidative stress and inflammation mediate the adverse effects of cadmium exposure on all-cause and cause-specific mortality in patients with diabetes and prediabetes.","authors":"Jingqi Liu, Kehan Chen, Mingyuan Tang, Qunzheng Mu, Shirong Zhang, Jiayuan Li, Jiaqiang Liao, Xia Jiang, Chuan Wang","doi":"10.1186/s12933-025-02698-5","DOIUrl":"10.1186/s12933-025-02698-5","url":null,"abstract":"<p><strong>Background: </strong>The effect of cadmium exposure on mortality risk among individuals with diabetes and prediabetes remains unclear, particularly regarding potential mediation by oxidative stress and inflammation. This study aimed to investigate the associations of blood cadmium levels with all-cause, cardiovascular disease (CVD), and cancer mortality and the mediating effects of oxidative stress and inflammation biomarkers in patients with diabetes and prediabetes.</p><p><strong>Methods: </strong>In this prospective cohort study, we analyzed 17,687 adults with diabetes and prediabetes from the National Health and Nutrition Examination Survey (NHANES, 1999-2018). Nine biomarkers related to oxidative stress (gamma-glutamyl transferase [GGT], uric acid [UA], high-density lipoprotein [HDL], UA to HDL ratio [UHR]) and inflammation (neutrophil-lymphocyte ratio [NLR], monocyte-lymphocyte ratio [MLR], neutrophil-monocyte-lymphocyte ratio [NMLR], systemic inflammation response index [SIRI], systemic immune-inflammation index [SII]) were systematically assessed. Kaplan-Meier survival analysis, Cox proportional hazards models, and restricted cubic splines (RCS) were applied to evaluate the association of cadmium with mortality risk. Generalized linear models were used to assess the association of cadmium with oxidative stress and inflammation biomarkers, while Cox regression and RCS evaluated their effects on mortality. Causal mediation analysis identified biological pathways mediated by oxidative stress and inflammation. Stratified and sensitivity analyses were further employed to confirm the robustness of the results.</p><p><strong>Results: </strong>During 161,047.75 person-years of follow-up, 3562 deaths occurred, including 1214 from CVD and 680 from cancer. Higher blood cadmium levels were associated with increased risks of all-cause mortality (fully adjusted hazard ratio [HR]: 2.17; 95% confidence interval [CI] 1.69-2.79, comparing highest vs. lowest quartile), CVD mortality (HR 2.06; 95% CI 1.41-3.02), and cancer mortality (HR 2.38; 95% CI 1.47-3.85), without evidence of nonlinear relationship. Mediation analyses indicated that UA, NLR, MLR, NMLR, and SIRI partially mediated the associations of cadmium with all-cause and CVD mortality, although the mediated proportions were relatively modest (ranging from 1.4 to 4.8%). Additionally, GGT mediated a small fraction of the associations with all-cause and cancer mortality.</p><p><strong>Conclusion: </strong>Cadmium exposure increases the risk of all-cause, CVD, and cancer mortality in patients with diabetes and prediabetes. Oxidative stress and inflammation appear to partially mediate this adverse effect. These findings emphasize the urgent need for targeted interventions to reduce cadmium-related mortality risks.</p><p><strong>Research insights: </strong>What is currently known about this topic? Cadmium exposure is linked to increased mortality. Oxidative stress and inflammation are critical","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"145"},"PeriodicalIF":8.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742516","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":"Anti-CD3 monoclonal antibody in treating patients with type 1 diabetes: an updated systematic review and meta-analysis.","authors":"Qi Wu, Rui Wei, Xinyue Liao, Xiaona Cui, Haining Wang, Tianpei Hong","doi":"10.1186/s12933-025-02696-7","DOIUrl":"10.1186/s12933-025-02696-7","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of anti-CD3 monoclonal antibody (mAb) in patients with type 1 diabetes (T1D) and identify the influencing factors.</p><p><strong>Methods: </strong>Randomized controlled trials comparing anti-CD3 mAb with placebo or standard care in T1D participants were screened from PubMed, Embase, and Cochrane databases until 31 May 2024. Changes in area under the curve (AUC) of C-peptide, HbA1c level and daily insulin requirement were main outcomes. Results were computed as standardized mean difference (SMD) and 95% confidence interval (CI). Meta-regression and subgroup analyses were also performed.</p><p><strong>Results: </strong>Eleven eligible trials involving 1573 T1D participants were included in this meta-analysis. Compared with control group, anti-CD3 mAb significantly increased AUC of C-peptide (SMD = 0.337, 95% CI 0.105 to 0.569, P = 0.004) and decreased daily insulin requirement (SMD =  - 0.598, 95% CI  - 0.927 to - 0.269, P < 0.001). Subgroup analysis revealed that low average age (≤ 18 years old: SMD = 0.546, 95% CI 0.203 to 0.889, P < 0.001), high cumulative dose of anti-CD3 mAb (≥ 25 mg: SMD = 0.588, 95% CI 0.424 to 0.752, P < 0.001), and short T1D diagnosis duration before enrollment (≤ 6 weeks: SMD = 0.609, 95% CI 0.405 to 0.814, P < 0.001) were significantly associated with an increase in AUC of C-peptide. Notably, meta-regression analysis revealed that cumulative dose was the most critical factor, masking the effect of average age and T1D diagnosis duration. Most adverse events were transient and could be medically treated.</p><p><strong>Conclusion: </strong>Anti-CD3 mAb effectively preserves C-peptide secretion and reduces insulin requirement in patients with T1D. Younger age (≤ 18 years), earlier treatment initiation (≤ 6 weeks post-diagnosis), higher cumulative doses (≥ 25 mg) may present better therapeutic effect.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"146"},"PeriodicalIF":8.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742461","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":"Heart rate variability tests for diagnosing cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus in advanced stages of kidney disease.","authors":"João Soares Felício, Maria Antônia Matos Araújo, Gabriela Nascimento de Lemos, Isabel Jacob Fernandes, Licia Oliveira Ruivo, Ester da Gama Chambouleyron, Lilian de Souza D'Albuquerque Silva, Caroline Filgueira Nunes, Gisely Mouta de Andrade Paes, Franciane Trindade Cunha de Melo, Pedro Paulo Freire Piani, Ana Regina Bastos Motta, Valéria Suênya Galvão Leal, Ana Carolina Contente Braga de Souza, Natercia Neves Marques de Queiroz, Márcia Costa Dos Santos, Karem Mileo Felício, Priscila Alcântara Barbosa de Figueiredo","doi":"10.1186/s12933-025-02666-z","DOIUrl":"https://doi.org/10.1186/s12933-025-02666-z","url":null,"abstract":"<p><p>Cardiovascular Autonomic Neuropathy (CAN) is one of the most devastating complications of Diabetes Mellitus (DM) and presents high morbidity and mortality. Its association with diabetic kidney disease (DKD) worsens the condition even further. CAN diagnosis remains a challenge and is being based on reflex tests which are laborious, risky and difficult to perform. Heart Rate Variability (HRV) tests has been suggested as having high utility in diagnosing CAN, but this issue remains controversial. The aim is to evaluate the sensitivity and specificity of HRV tests to diagnose CAN in patients with type 2 diabetes mellitus (T2DM) and DKD with severely increased albuminuria. This is a cross-sectional study in patients with T2DM and DKD with severely increased albuminuria. A total of 48 subjects were recruited and underwent laboratory and neuropathy assessment. The diagnosis of CAN was first confirmed in 75% (36/48) of patients based on cardiovascular autonomic reflex tests (CARTs). HRV tests (VLF, LF, TP and SDNN) differed between groups with and without CAN (212 vs. 522 ms², p = 0.024; 57 vs. 332 ms², p = 0.025; 359.5 vs. 2733 ms², p = 0.007; 20 vs. 48 ms, p = 0.012), respectively. The best cut-off points based on ROC curve were < 1,117 ms², < 152.5 ms², < 1,891 ms² and < 46.5 ms, respectively. VLF and TP reached highest sensitivity values (97% and 92%) and F1 Score of 90%, while LF had best specificity (75%) and TP had best accuracy (85%). Our best model of serial algorithm using VLF as first screening test and TP in sequency obtained a sensitivity of 97% and accuracy of 90%, reducing in 90% the need to perform CARTs. Our findings suggest that it is possible to achieve high sensitivity and accuracy using an algorithm with VLF and TP parameters analyzed in series. It could enable a simpler and early diagnosis, avoiding CARTs complications.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"144"},"PeriodicalIF":8.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742467","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":"Pericoronary adipose tissue attenuation predicts compositional plaque changes: a 12-month longitudinal study in individuals with type 2 diabetes without symptoms or known coronary artery disease.","authors":"Katrine Schultz Overgaard, Thomas Rueskov Andersen, Laurits Juhl Heinsen, Gokulan Pararajasingam, Roda Abdulkadir Mohamed, Freja Sønder Madsen, Irmelin Irene Aagaard Biesenbach, Kurt Højlund, Jess Lambrechtsen, Søren Auscher, Kenneth Egstrup","doi":"10.1186/s12933-025-02694-9","DOIUrl":"https://doi.org/10.1186/s12933-025-02694-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pericoronary adipose tissue attenuation (PCATa), derived from coronary computed tomography angiography (CCTA), is a novel marker of inflammation in the coronary arteries. Patients with type 2 diabetes mellitus (T2DM) are at elevated risk of coronary artery disease (CAD), potentially due to systemic inflammation. This study evaluated whether baseline PCATa predicts changes in plaque composition and burden over 12 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective longitudinal study included 200 participants with T2DM, who had neither symptoms nor a prior diagnosis of CAD (mean age 61 ± 9.4 years, 72% male). PCATa was measured at the baseline scan along the proximal 40 mm of each major coronary artery, and the values were averaged to calculate the participant-level PCATa. High PCATa levels were determined using the validated cut-off of -70.1 Hounsfield units. Compositional plaque changes were quantified as the differences between baseline and 12-month scans, and plaque burden was calculated as the normalized atheroma volume. Multivariable regression analyses assessed the associations between baseline PCATa and compositional plaque changes and evaluated risk factors, including high PCATa, in predicting non-calcified plaque burden progression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Plaque compositional volumes and burden increased over 12 months, while PCATa remained stable. After multivariable adjustments, baseline PCATa was significantly associated with changes in total plaque volume (β = 0.005, p = 0.005), non-calcified plaque volume (β = 0.006, p = 0.007), total plaque burden (β = 1.7, p = 0.007), and non-calcified plaque burden (β = 2.0, p = 0.006), but not with calcified plaque volume or burden. High baseline PCATa was observed in 44 participants (22%) and was the only independent predictor of non-calcified plaque burden progression (odds ratio 3.5, p = 0.002).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Baseline PCATa is significantly associated with increases in total and non-calcified plaque volumes and burden over 12 months in participants with T2DM without symptoms or known CAD. High PCATa levels uniquely predict non-calcified plaque burden progression, suggesting that PCATa may serve as a marker for subclinical atherosclerosis progression. This warrants further investigation into PCATa for cardiovascular risk assessment, particularly in high-risk populations such as individuals with T2DM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;Trial registration: NCT06644651.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Research insights: &lt;/strong&gt;What is currently known about this topic? 1. Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) share inflammatory mechanisms. 2. Individuals with T2DM face a two- to four-fold increased risk of CAD compared with those without T2DM. 3. Pericoronary adipose tissue attenuation (PCATa) is a novel marker of coronary inflammation. What is the key research question? Can baseline PCATa predict compositional ","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"143"},"PeriodicalIF":8.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742517","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 between C-reactive protein-triglyceride glucose index and stroke risk in different glycemic status: insights from the China Health and Retirement Longitudinal Study (CHARLS).","authors":"Guijun Huo, Yao Tang, Zhanao Liu, Junjie Cao, Zhichao Yao, Dayong Zhou","doi":"10.1186/s12933-025-02686-9","DOIUrl":"10.1186/s12933-025-02686-9","url":null,"abstract":"<p><strong>Objective: </strong>C-reactive protein-triglyceride-glucose index (CTI) has been proposed as a novel biomarker for insulin resistance and inflammation. However, the association between CTI and the risk of stroke, particularly in individuals with different glycemic status, remains unclear.</p><p><strong>Methods: </strong>A total of 10,443 middle-aged and elderly participants were enrolled from the China Health and Retirement Longitudinal Study (CHARLS). The primary endpoint was the occurrence of stroke events. The CTI was calculated using the formula 0.412* Ln (CRP [mg/L]) + Ln (TG [mg/dl] × FPG [mg/dl])/2. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between CTI and the risk of stroke according to gender, age and glycemic status.</p><p><strong>Results: </strong>During a median follow-up of 9 years, 960 (9.2%) participants experienced a stroke. Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association was similar between male and female, despite the HR tended to be higher in females (HR 1.22, 95% CI 1.09, 1.36) than males (HR 1.15, 95% CI 1.02, 1.29), and similar in middle-aged (HR 1.25, 95% CI 1.11, 1.41) and elderly participants (HR 1.12, 95% CI 1.00, 1.26). In different glycemic status, high levels of CTI were found to be linked to an increased risk of stroke in individuals with normal glucose regulation (NGR) (HR 1.33, 95% CI 1.11, 1.59) and prediabetes mellitus (Pre-DM) (HR 1.20, 95% CI 1.04, 1.39). However, this association was not observed in individuals with diabetes mellitus (DM).</p><p><strong>Conclusions: </strong>Our findings revealed a significant positive linear relationship between CTI and the occurrence of stroke. The association between CTI and stroke was similar between male and female, and similar in middle-aged and elderly participants. In different glycemic status, the association was significant in individuals with NGR and Pre-DM.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"142"},"PeriodicalIF":8.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718080","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":"Early hemodynamic impact of SGLT2 inhibitors in overweight cardiometabolic heart failure: beyond fluid offloading to vascular adaptation- a preliminary report.","authors":"Nadia Salerno, Jessica Ielapi, Angelica Cersosimo, Isabella Leo, Assunta Di Costanzo, Giuseppe Armentaro, Salvatore De Rosa, Angela Sciacqua, Sabato Sorrentino, Daniele Torella","doi":"10.1186/s12933-025-02699-4","DOIUrl":"10.1186/s12933-025-02699-4","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is increasingly recognized as a heterogeneous cardiometabolic disorder, often in the context of overweight/obesity independently from diabetes. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce HF hospitalizations and cardiovascular mortality across ejection fraction (EF) categories, yet their early hemodynamic effects in cardiometabolic HF, and with preserved ejection fraction (HFpEF) in particular, remain underexplored.</p><p><strong>Methods: </strong>A prospective, single-center study included 20 consecutive HF patients receiving SGLT2i alongside optimized therapy. Transthoracic echocardiography and non-invasive bioimpedance assessments (NICaS system) were performed at baseline and after 4 weeks.</p><p><strong>Results: </strong>The median patient age was 75 years [58-84], with 14 patients (70%) being overweight/obese, and only 4 patients with diabetes. The majority (65%) had HF with preserved EF (HFpEF), 25% with mildly reduced EF (HFmrEF), and 10% with reduced EF (HFrEF). At a median follow-up of 33 days [30-68], significant reductions were observed in body weight (67.65 kg [46-99.20] to 65.50 kg [46.30-97], p = 0.027) and systolic blood pressure (130 mmHg [100-150] to 116.50 mmHg [100-141], p = 0.015). Hemodynamic assessments revealed a significant decrease in total peripheral resistance index (TPRi, 3616.50 dynes·sec·cm3 [1600-5024] to 3098.50 dynes·sec·cm3 [1608-4684], p = 0.002). The left atrial volume index decreased significantly (42.84 ml/m² [27-69.40] to 41.15 ml/m² [26-62.60], p < 0.001); a significant decrease in peak tricuspid regurgitation velocity [2.52 m/Sect. (1.30-3.20]), vs. 2.21 m/Sect. (1.44-2.92), p = 0.023] and in pulmonary artery systolic pressure (PASP) [31.0 mmHg (15.0-40.0) vs. 25.50 mmHg (15.0-38.0-), p = 0.010] was observed. Patients with HFrEF or HFmrEF showed significant reduction in total body water (66.33 [51.45-74.45] vs. 58.68 [55.13-66.50]), while HFpEF patients (overweight/obese, n = 11, 79%) had a significant reduction in TPRi (3681 dynes·sec·cm3 [1600-5024] vs. 3085 dynes·sec·cm3 [1608-4684] p = 0.005).</p><p><strong>Conclusions: </strong>Early hemodynamic responses to SGLT2i may differ across HF subtypes. In overweight patients with cardiometabolic HFpEF, our preliminary findings suggest an association with reduced vascular resistance, while in HFrEF/HFmrEF, the primary benefit appears to be volume unloading. However, the vascular effects of SGLT2i remain uncertain, and given the small sample size, these results should be interpreted as hypothesis-generating. Our findings also highlight the potential role of non-invasive hemodynamic monitoring in guiding therapy in HF.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"141"},"PeriodicalIF":8.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718087","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":"Cardiovascular abnormalities already occurred in newly-diagnosed patients with early-onset type 2 diabetes.","authors":"Hong Lian, Qian Ren, Wei Liu, Rui Zhang, Xiantong Zou, Simin Zhang, Yingying Luo, Wei Deng, Qiuping Wang, Lin Qi, Yufeng Li, Wenbo Wang, Liyong Zhong, Pengkai Zhang, Chengcheng Guo, Li Li, Yating Li, Tianhao Ba, Chaochao Yang, Lili Huo, Yan'ai Wang, Chunxia Li, Dejun Hao, Yajing Zhang, Yan Xu, Fang Wang, Xiangqing Wang, Fang Zhang, Siqian Gong, Wenjia Yang, Xueyao Han, Linong Ji","doi":"10.1186/s12933-025-02665-0","DOIUrl":"10.1186/s12933-025-02665-0","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of early-onset type 2 diabetes (EOD) is rapidly increasing. This study intends to screen for early cardiovascular abnormalities in patients newly diagnosed with EOD and evaluate the cardiovascular risk across cluster phenotypes.</p><p><strong>Method: </strong>A total of 400 patients ≤ 40 years old with newly diagnosed type 2 diabetes were enrolled from the START cohort (the Study of The newly diAgnosed eaRly onset diabeTes). Cluster classification was performed using the K-means method based on age, BMI, HbA1c, HOMA2-β, HOMA2-IR, and GAD antibodies. Echocardiography and carotid ultrasound were performed within 3 months of diabetes diagnosis. Carotid ultrasound abnormalities included intimal thickening and plaque formation, while echocardiography assessed changes in cardiac structure and systolic/diastolic function. Cluster-specific partitioned polygenic scores (pPS) were used to validate our findings from a genetic perspective.</p><p><strong>Result: </strong>Carotid artery abnormalities were detected in 26.3% of patients, and echocardiography abnormalities were observed in 20.0%. Patients with severe insulin resistant diabetes (SIRD) had the highest incidence of carotid artery abnormality (40.0%). After adjusting for relevant risk factors, fasting C-peptide levels were significantly associated with a 1.247-fold increase in the risk of carotid artery abnormalities. Left atrial enlargement was more prevalent in the SIRD (16.7%) and mild obesity-related diabetes (MOD) (18.5%) classifications. A high proportion of patients with SIRD had abnormal left ventricular geometry (36.1%). Increases in BMI, fasting C-peptide level and HOMA2IR were accompanied by a further increase in left atrial enlargement risk by 1.136-, 1.781- and 1.687-fold respectively. The pPS for lipodystrophy was higher in the EOD group with plaque formation, and showed a significant linear correlation with the ratio of the left atrial anteroposterior diameter to body surface area (LAAP/BSA) (R = 0.344, p < 0.001).</p><p><strong>Conclusion: </strong>Heart and carotid artery abnormalities are common in patients with early-onset T2DM at the time of diagnosis. Patients with obesity and insulin resistance are at higher risk for cardiovascular abnormalities. Cluster classification based on clinical characteristics enables more accurate identification of patients at increased risk of cardiovascular complications at an early stage.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"140"},"PeriodicalIF":8.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718084","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":"BMI-residualized data uncovers a cluster of people with type 2 diabetes and increased serum ferritin protected from cardiovascular disease.","authors":"Laura Gallardo-Nuell, Jordi Blanch, Yenny Leal, Daniel E Coral, Talita Duarte-Salles, Giuseppe N Giordano, Paul W Franks, Ewan R Pearson, Geltrude Mingrone, Carel W le Roux, Rafael Ramos, José Manuel Fernández-Real","doi":"10.1186/s12933-025-02685-w","DOIUrl":"10.1186/s12933-025-02685-w","url":null,"abstract":"<p><strong>Background: </strong>Understanding the relationship between serum ferritin levels and cardiovascular outcomes in type 2 diabetes is crucial for improving risk stratification and guiding therapeutic interventions aimed at preventing major adverse cardiovascular events (MACE). This study aimed to identify distinct clusters of individuals with type 2 diabetes who have varying risks of MACE using a data-driven clustering approach.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from 49,506 individuals within a multicenter, population-based primary care registry in Catalonia, Spain. Individuals diagnosed with type 2 diabetes at age 35 or older were recruited between January 2010 and December 2021 and followed for at least 10 years. Biomarkers associated with cardiovascular risk-including serum glucose, HbA1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, serum ferritin, leukocyte, and monocyte counts-were examined. Clustering analysis was applied to identify patient subgroups, and Cox proportional hazards models were used to assess associations with cerebrovascular events, coronary events, and composite MACE.</p><p><strong>Results: </strong>Five distinct clusters were identified, characterized by differences in serum glucose, HbA1c, lipid profiles, blood pressure, and serum ferritin levels. Individuals with discordantly high serum ferritin levels relative to their body mass index (BMI) exhibited a lower risk of adverse cardiovascular outcomes. In men, hazard ratios (HR) were 0.68 (95% confidence interval [CI]: 0.53-0.87) for cerebrovascular events, 0.65 (95% CI 0.49-0.88) for coronary events, and 0.68 (95% CI 0.56-0.83) for MACE. In women, HRs were 0.81 (95% CI 0.67-0.92) for cerebrovascular events, 0.73 (95% CI 0.57-0.95) for coronary events, and 0.79 (95% CI 0.67-0.92) for MACE.</p><p><strong>Conclusions: </strong>Individuals with type 2 diabetes who exhibit higher-than-expected serum ferritin levels relative to their BMI may have a lower risk of cardiovascular events. These findings suggest that ferritin may play a more complex role in cardiovascular risk than previously assumed and highlight the potential for refined risk stratification strategies in type 2 diabetes management.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"139"},"PeriodicalIF":8.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718082","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 prognostic significance of stress hyperglycemia ratio in evaluating all-cause and cardiovascular mortality risk among individuals across stages 0-3 of cardiovascular-kidney-metabolic syndrome: evidence from two cohort studies.","authors":"Mo-Yao Tan, Yu-Jun Zhang, Si-Xuan Zhu, Shan Wu, Ping Zhang, Ming Gao","doi":"10.1186/s12933-025-02689-6","DOIUrl":"10.1186/s12933-025-02689-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The American Heart Association (AHA) proposed the concept of cardiovascular-kidney-metabolic (CKM) syndrome, underscoring the interconnectedness of cardiovascular, renal, and metabolic diseases. The stress hyperglycemia ratio (SHR) represents an innovative indicator that quantifies blood glucose fluctuations in patients experiencing acute or subacute stress, correlating with detrimental clinical effects. Nevertheless, the prognostic significance of SHR within individuals diagnosed with CKM syndrome in stages 0 to 3, particularly with respect to all-cause or cardiovascular disease (CVD) mortality risks, has not been fully understood yet.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The current study analyzed data from 9647 participants with CKM syndrome, covering stages 0 to 3, based on the NHANES (National Health and Nutrition Examination Survey) collected from 2007 to 2018. In this study, the primary exposure variable was the SHR, computed as fasting plasma glucose divided by (1.59 * HbA1c - 2.59). The main endpoints of study were all-cause mortality as well as CVD mortality, with death registration data sourced through December 31, 2019. The CHARLS database (China Health and Retirement Longitudinal Study) was utilized as validation to enhance the reliability of the findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 9647 NHANES participants, who were followed for a median duration of 6.80 years. During this period, 630 all-cause mortality cases and 135 CVD-related deaths in total were recorded. After full adjustment for covariates, our results displayed a robust positive association of SHR with all-cause mortality (Hazard ratio [HR] = 1.09, 95% Confidence interval [CI] 1.04-1.13). However, the SHR exhibited no significant relationship with CVD mortality (HR = 1.00, 95% CI 0.91-1.11). The mediation analysis results suggested that the relationship between SHR and all-cause mortality risk is partially mediated by RDW, albumin, and RAR. Specifically, the mediating effects were - 17.0% (95% CI - 46.7%, - 8.7%), - 10.1% (95% CI - 23.9%, - 4.7%), and - 23.3% (95% CI - 49.0%, - 13.0%), respectively. Additionally, analyses of the CHARLS database indicated a significant positive correlation between SHR and all-cause mortality among individuals diagnosed with CKM across stages 0-3 during the follow-up period from 2011 to 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;An increased SHR value is positively associated with an elevated likelihood of all-cause mortality within individuals diagnosed with CKM syndrome across stages 0-3, yet it shows no significant association with CVD mortality. SHR is an important tool for predicting long-term adverse outcomes in this population. Cardiovascular-kidney-metabolic (CKM) syndrome emphasizes the interconnectedness of cardiovascular, kidney, and metabolic diseases. The stress hyperglycemia ratio (SHR) is a novel marker reflecting stress-induced glucose fluctuations, but its prognostic value in ","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"137"},"PeriodicalIF":8.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699775","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 between triglyceride-glucose index and mortality in critically ill patients with atrial fibrillation: a retrospective cohort study.","authors":"Rong Ding, Erjing Cheng, Miao Wei, Liya Pan, Lu Ye, Yi Han, Xuan Zhang, Chao Xue, Jianqiang Li, Jiannan Gong, Hui Zhao","doi":"10.1186/s12933-025-02697-6","DOIUrl":"10.1186/s12933-025-02697-6","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index, an emerging surrogate marker of insulin resistance, has been implicated in adverse cardiovascular outcomes. However, its prognostic value in critically ill patients with atrial fibrillation (AF) remains unclear. This study aimed to investigate the association between the TyG index and all-cause mortality in this high-risk population.</p><p><strong>Methods: </strong>We identified critically ill patients with AF from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and categorized them into tertiles based on their TyG index levels. The primary outcome was 30-day mortality, with 90-day and 365-day all-cause mortality as secondary outcomes. Cox proportional hazards regression analysis and restricted cubic splines were used to elucidate the relationship between the TyG index and all-cause mortality. Kaplan-Meier survival analysis was performed to visualize survival differences among the tertiles.</p><p><strong>Results: </strong>A total of 1473 patients were included; the 30-day, 90-day, and 365-day all-cause mortality rates were 26.8%, 33.3%, and 41.1%, respectively. Multivariate Cox proportional hazards analysis revealed that the TyG index was independently associated with mortality at 30 days [hazard ratio (HR) (95% confidence interval (CI)) 1.26 (1.09-1.45), P = 0.002], 90 days [HR (95% CI) 1.27 (1.11-1.45), P < 0.001], and 365 days [HR (95% CI) 1.24 (1.10-1.40), P < 0.001]. Restricted cubic splines regression showed a positive linear association between the TyG index and mortality risk. Kaplan-Meier survival curves further confirmed the significant survival disparities across TyG index tertiles.</p><p><strong>Conclusions: </strong>A significant linear association was observed between higher TyG index and increased all-cause mortality at 30, 90, and 365 days in critically ill patients with AF. This underscores the role of the TyG index as a key prognostic indicator for risk stratification and management in intensive care.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"138"},"PeriodicalIF":8.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699773","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}