Cardiovascular Diabetology最新文献

{"title":"A one-week reduced-carbohydrate diet to mitigate iatrogenic peripheral hyperinsulinemia does not improve insulin sensitivity or endothelial function in a randomized, crossover trial in patients with type 1 diabetes.","authors":"Justin M Gregory, T Jordan Smith, Sara H Duffus, David Brooks, M Naweed Akbar, Margaret-Anne Huntley, JoAnn A Gottlieb, Lauren M LeStourgeon, Christopher S Wilson, Joshua A Beckman, Alan D Cherrington","doi":"10.1186/s12933-025-02658-z","DOIUrl":"10.1186/s12933-025-02658-z","url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic peripheral hyperinsulinemia, resulting from peripheral insulin administration in type 1 diabetes, may increase insulin resistance and impair endothelial function. We hypothesized that lowering iatrogenic peripheral hyperinsulinemia via a one-week, reduced-carbohydrate diet (RCD) would improve insulin sensitivity and endothelial function compared with an isocaloric standard carbohydrate diet (SCD).</p><p><strong>Methods: </strong>In this randomized, single-blinded, crossover trial, we studied 12 adults with type 1 diabetes. Participants completed both a one-week RCD and a one-week SCD, separated by a three-week washout. After each intervention, we measured insulin sensitivity using a hyperinsulinemic-euglycemic clamp and assessed endothelial function via brachial-artery flow-mediated vasodilation (FMD).</p><p><strong>Results: </strong>The RCD reduced total daily insulin doses by 16% compared with the SCD. Despite this reduction, insulin sensitivity did not improve (median glucose infusion rates: RCD 8.1 mg/kg FFM/min [IQR 6.7-10.1] vs. SCD 8.6 mg/kg FFM/min [7.0-11.0], p = 0.47). Similarly, endothelial function did not differ significantly (FMD after RCD 7.50% [3.25-15.5] vs. SCD 9.81% [4.96-14.3], p = 0.91). Although higher insulin doses correlated with lower insulin sensitivity under both conditions, lowering insulin dose through the RCD alone did not yield measurable improvements.</p><p><strong>Conclusions: </strong>Although a one-week RCD significantly lowered insulin requirements, it failed to enhance insulin sensitivity or endothelial function in adults with type 1 diabetes. These findings underscore the complex and dynamic relationship between insulin exposure and cardiometabolic health. Similar basal overnight insulin delivery may have masked potential benefits by the time of testing, highlighting the need for further studies to refine strategies aimed at mitigating hyperinsulinemia's adverse effects.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04118374.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"107"},"PeriodicalIF":8.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566107","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":"Aortic valve calcification across stages of dysglycemia in middle-aged individuals from the general population.","authors":"Anne Wang, Carl Johan Östgren, Anna Norhammar, David Kylhammar, Tomas Jernberg, Lars Lind, Stefan Söderberg, Anders Blomberg, Gunnar Engström, Göran Bergström, Magnus Settergren, Bahira Shahim","doi":"10.1186/s12933-025-02634-7","DOIUrl":"10.1186/s12933-025-02634-7","url":null,"abstract":"<p><strong>Background: </strong>Aortic valve calcification (AVC) is an underlying pathophysiological mechanism in aortic stenosis, which shares many risk factors with diabetes. However, the association between dysglycemia and early stages of AVC remains unclear. The aim was to examine the associations between stages of dysglycemia and signs of AVC among middle-aged individuals from the general population.</p><p><strong>Methods: </strong>This was a cross-sectional study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) randomly enrolling 30,154 middle-aged men and women from six study sites in Sweden between 2013 and 2018. Glycemic status was based on the World Health Organization criteria (fasting blood glucose and/or HbA1c) and questionnaire-based answers on previous diseases and categorized as normoglycemia, prediabetes, newly detected diabetes and known diabetes. AVC was assessed on cardiac computed tomography (CT) and defined as evident or not.</p><p><strong>Results: </strong>Of 29,331 individuals with data on glycemic status and AVC available, mean age was 57.5 years and normoglycemia was present in 76%, prediabetes in 16%, newly detected diabetes in 3% and known diabetes in 5%. The prevalence of AVC increased progressively across glycemic categories, particularly in males (8%, 11%, 14% and 17%; P < 0.01) compared to females (5%, 6%, 8% and 9%; P < 0.01). There was an association with AVC already in the early stages of dysglycemia; prediabetes (OR 1.16, 95% CI 1.02-1.31), newly detected diabetes (1.34 [1.05-1.71]) and known diabetes (1.61 [1.34-1.93]) after adjusting for age, sex, smoking, study site, low density lipoprotein-cholesterol and hypertension.</p><p><strong>Conclusions: </strong>In this large, contemporary, and randomly selected population of middle-aged individuals, prediabetes, newly detected diabetes and known diabetes were all associated with CT-detected AVC. Further studies are warranted to investigate if managing dysglycemia, even in its early stages, may help slow down AVC progression.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"105"},"PeriodicalIF":8.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566109","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":"Circulating mitochondrial DNA signature in cardiometabolic patients.","authors":"Alessandro Mengozzi, Silvia Armenia, Nicolò De Biase, Lavinia Del Punta, Federica Cappelli, Emiliano Duranti, Virginia Nannipieri, Rossana Remollino, Domenico Tricò, Agostino Virdis, Stefano Taddei, Nicola Riccardo Pugliese, Stefano Masi","doi":"10.1186/s12933-025-02656-1","DOIUrl":"10.1186/s12933-025-02656-1","url":null,"abstract":"<p><strong>Background: </strong>Mitochondrial dysfunction is a hallmark of cardiometabolic diseases. Circulating mitochondrial DNA (mtDNA) profiles could refine risk stratification, but current methods do not account for different fractions of circulating mtDNA. We investigated whether patients with type 2 diabetes and/or heart failure (HF) have a specific signature of the total circulating mtDNA profile, including intracellular and cell-free fractions.</p><p><strong>Methods: </strong>We performed a complete clinical assessment, including blood tests, 12-lead ECG and ultrasound at rest and during cardiopulmonary exercise. Ultrasound congestion was defined at rest as inferior vena cava of ≥ 21 mm, lung B-lines ≥ 4, or discontinuous renal venous flow. In fasting whole blood and plasma samples collected at rest, we simultaneously measured the copy number of the cellular and cell-free components of mtDNA by real-time quantitative polymerase chain reaction (qPCR) using custom standards. We calculated the ratio of cell mtDNA to cell-free mtDNA as an index of mitochondrial efficiency.</p><p><strong>Results: </strong>We enrolled 120 consecutive patients: 50 (42%) with HF and preserved ejection fraction (HFpEF), 40 (33%) with HF and reduced ejection fraction (HFrEF) and 30 (25%) at risk of developing HF; 42/120 (35%) had diabetes. Cell-free mtDNA was increased in patients with HF (with higher levels in HFrEF than HFpEF) and those with diabetes. Cell-free mtDNA was also higher in patients with systemic inflammation (expressed by high-sensitivity C-reactive protein [hs-CRP] ≥ 0.2 mg/dL with neutrophil-lymphocyte ratio [NLR] > 3) and more ultrasound signs of congestion. The cell/cell-free mtDNA ratio showed opposite trends (all p < 0.05), but there were no significant differences in cell mtDNA. Cell-free mtDNA and mtDNA ratio independently predicted the presence of ≥ 2 ultrasound signs of congestion and effort intolerance (peak oxygen consumption < 16 mL/kg/min) at ROC analysis and using multivariable regressions after adjustment for age, sex, hs-CRP, NLR, high-sensitivity Troponin T and NT-proBNP.</p><p><strong>Conclusions: </strong>Patients with HF and diabetes have an altered circulating mtDNA signature characterised by higher cell-free mtDNA and lower mtDNA ratio, whereas cellular mtDNA remains unaffected. Cell-free mtDNA and mtDNA ratio are associated with impaired response to exercise, higher systemic inflammation and increased congestion. Circulating mitochondrial profile could be a new biomarker of mitochondrial status in cardiometabolic diseases.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"106"},"PeriodicalIF":8.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566112","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":"Long-term trajectory of estimated glomerular filtration rate in ambulatory patients with type 2 diabetes and heart failure: clinical insights and prognostic implications.","authors":"Maria Teresa Julián, Pau Codina, Josep Lupón, Elisabet Zamora, Alejandra Pérez-Montes de Oca, Mar Domingo, Evelyn Santiago-Vacas, Andrea Borrellas, María Ruiz-Cueto, Carlos González-Gallego, Maribel Troya, Gregorio A Romero-González, Nuria Alonso, Antoni Bayes-Genis","doi":"10.1186/s12933-025-02632-9","DOIUrl":"10.1186/s12933-025-02632-9","url":null,"abstract":"<p><strong>Background: </strong>Although previous studies have evaluated renal function decline in patients with heart failure (HF), there is limited evidence on long-term renal trajectories, especially in patients with concomitant HF and type 2 diabetes (T2D). This study aims to provide a detailed analysis of renal function decline over an extended follow-up period in a well-characterized cohort of patients with HF and T2D.</p><p><strong>Methods: </strong>This is a post hoc subanalysis of a prospective registry involving ambulatory patients with HF and T2D referred to a specialized HF clinic. The estimated glomerular filtration rate (eGFR) was assessed at baseline and during scheduled follow-up visits every three months using the Chronic Kidney Disease Epidemiology Collaboration formula. Loess curves were plotted for predefined subgroups, and multivariable longitudinal Cox regression analyses were performed to evaluate the associations between eGFR trajectories and all-cause mortality.</p><p><strong>Results: </strong>A total of 1,114 patients with HF and T2D were included, with a mean age of 69.3 ± 10.3 years, and 68.2% were men. In total, 10,830 scheduled creatinine measurements were analysed, with a mean of 15.8 ± 9.4 measurements per patient. A significant progressive decline in the eGFR was observed, with an average annual rate of - 2.05 (95% CI - 2.11 to - 1.95, p < 0.001) ml/min/1.73 m². Subgroup analysis indicated that older age, nonischaemic HF aetiology, HFpEF or HFmrEF, poor glycaemic control, and higher baseline eGFRs were associated with a more pronounced decline in renal function. Furthermore, a decrease in the eGFR was independently associated with an increased risk of all-cause mortality.</p><p><strong>Conclusions: </strong>This study offers novel insights into long-term renal function trajectories in patients with HF and T2D and identifies key clinical factors associated with accelerated renal decline. Future research is warranted to validate these results in larger, more diverse cohorts and to explore potential therapeutic interventions.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"104"},"PeriodicalIF":8.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566180","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":"Atherogenic index of plasma, high sensitivity C-reactive protein and incident diabetes among middle-aged and elderly adults in China: a national cohort study.","authors":"Tongshuai Wang, Mengru Zhang, Wenxing Shi, Yongzhen Li, Tiantian Zhang, Wenming Shi","doi":"10.1186/s12933-025-02653-4","DOIUrl":"10.1186/s12933-025-02653-4","url":null,"abstract":"<p><strong>Background: </strong>The atherogenic index of plasma (AIP) and systematic inflammation, as measured by high-sensitivity C-reactive protein (hsCRP), are predictors of diabetes, but their combined impacts on incident diabetes are poorly understood. Using a nationally representative cohort in China, we aimed to investigate the association of AIP and hsCRP with incident diabetes among middle-aged and elderly adults.</p><p><strong>Methods: </strong>This cohort comprised 9,112 participants aged at least 45 years from 125 cities in the China Health and Retirement Longitudinal Study who were free of diabetes at baseline in 2011. Of these, 5,048 participants were followed up until 2015. The AIP was calculated as Log10[TG (mg/dL)/HDL-C(mg/dL)]. Multivariate logistic regression and linear mixed-effect (LME) models were performed to evaluate the associations of AIP, hsCRP, and incident diabetes as well as glycemic biomarkers. Receiver operating characteristic (ROC) curves were used to evaluate their diagnostic values. We conducted a mediation analysis to assess the direct and indirect associations between AIP and hsCRP with diabetes.</p><p><strong>Results: </strong>489 (9.7%) cases developed diabetes during four years. Higher levels of AIP and hsCRP were independently associated with diabetes. Compared to the lowest quartile of AIP or hsCRP, the highest quartile of AIP (adjusted odds ratio, aOR 2.53, 95% CI: 1.90-3.38) and hsCRP (aOR 2.38, 1.79-3.16) was significantly associated with incident diabetes. The joint effects showed that participants with higher levels of AIP and hsCRP had significantly higher aOR of 2.76 (2.13-3.57). The LME models showed AIP and hsCRP were related to an increased level of fasting blood glucose and glycated hemoglobin. The combination of AIP and hsCRP has better predictive efficacy (area under the curve, AUC: 0.628, 0.601-0.654) for incident diabetes than alone. Mediation analyses showed that high AIP significantly mediated 25.4% of the association between hsCRP and diabetes, and hsCRP simultaneously mediated 5.7% of the association between AIP and diabetes.</p><p><strong>Conclusions: </strong>This cohort suggests combined effects and mutual mediation between the AIP and hsCRP on incident diabetes in China. Our findings provide clinical implications for monitoring and managing AIP and hsCRP levels to mitigate the development of diabetes.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"103"},"PeriodicalIF":8.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566110","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 triglyceride glucose-body mass index and the combination of sedentary behavior and physical activity with risks of all-cause mortality and myocardial infarction: a cohort study from the UK biobank.","authors":"Ying Zhu, Tianci Yao, Li Tian, Yan Zhang, Qinmei Ke","doi":"10.1186/s12933-025-02652-5","DOIUrl":"10.1186/s12933-025-02652-5","url":null,"abstract":"<p><strong>Background: </strong>Triglyceride glucose-body mass (TyG-BMI) index, sedentary behavior (SB) and physical activity (PA) are independently associated with all-cause mortality and myocardial infarction (MI). However, it remains unclear whether TyG-BMI index and the combination of SB and PA exhibit joint effects on all-cause mortality and MI.</p><p><strong>Methods: </strong>Among 502 356 participants from the UK Biobank, 297 761 eligible participants were selected. The Cox proportional hazards model and the restricted cubic spline regression model were used to assess the associations of TyG-BMI with all-cause mortality and MI. To conduct stratified analysis, participants were classified into four groups by SB (<6 h/d and ≥ 6 h/d) and moderate to vigorous physical activity (MVPA) (<150 min/wk and ≥ 150 min/wk). Additionally, the multiplicative interaction was assessed between TyG-BMI and SB & MVPA. Furthermore, to estimate their joint associations, participants were conjointly classified into twelve new groups by TyG-BMI (tertiles) and SB & MVPA (four groups).</p><p><strong>Results: </strong>During a median follow-up of 13.8 and 13.6 years, 21 335 deaths and 9 116 MI were observed, respectively. The dose-response relationship of TyG-BMI with all-cause mortality was U-shaped with a cut-off point at 225.09, whereas the relationship with MI was positive nonlinear with a cut-off point at 266.87. A synergistic effect on all-cause mortality was observed between TyG-BMI tertile 1 and ≥ 6 h/d SB & <150 min/wk MVPA (P for interaction < 0.001). When MVPA ≥ 150 min/wk combined with SB either <6 h/d or not, TyG-BMI tertile 2 showed no significant association with all-cause mortality risk, with HRs(95%CIs) of 0.98 (0.93-1.03) for <6 h/d SB and 1.00 (0.94-1.07) for ≥ 6 h/d SB. When one of the two healthy behaviors was present (i.e., either <6 h/d SB with <150 min/wk MVPA, or ≥ 150 min/wk MVPA with ≥ 6 h/d SB), its combination with TyG-BMI tertile 1 showed no significant association with MI risk, with HRs(95%CIs) of 1.07(0.95-1.20) and 1.09(0.94-1.25), respectively.</p><p><strong>Conclusions: </strong>TyG-BMI index and the combination of SB and PA were independently and jointly associated with risks of all-cause mortality and MI. Our findings highlight the importance of improving insulin resistance to reduce all-cause mortality risk, particularly in individuals with long-term SB and insufficient PA, who are more susceptible to the adverse effects of TyG-BMI index. In long-term sedentary individuals, meeting PA guidelines (≥ 150 min/wk of MVPA) effectively mitigated risks of all-cause mortality and MI associated with TyG-BMI index.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"102"},"PeriodicalIF":8.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536573","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":"Comprehensive evaluation of diabetes subtypes in a European cohort reveals stronger differences of lifestyle, education and psychosocial parameters compared to metabolic or inflammatory factors.","authors":"Nathalie Rohmann, Johannes Epe, Corinna Geisler, Kristina Schlicht, Kathrin Türk, Katharina Hartmann, Lucy Kruse, Julia Koppenhagen, Ahmad Yusuf Kohestani, Tanja Adam, Corinna Bang, Andre Franke, Dominik M Schulte, Tim Hollstein, Matthias Laudes","doi":"10.1186/s12933-025-02660-5","DOIUrl":"10.1186/s12933-025-02660-5","url":null,"abstract":"<p><strong>Background: </strong>The traditional binary classification of diabetes into Type 1 and Type 2 fails to capture the heterogeneity among diabetes patients. This study aims to identify and characterize diabetes subtypes within the German FoCus cohort, using the ANDIS cohort's classification framework, and to explore subtype-specific variations in metabolic markers, gut microbiota, lifestyle, social factors, and comorbidities.</p><p><strong>Methods: </strong>We utilized data from 416 participants (208 with diabetes and 208 matched metabolically healthy controls) from the German FoCus cohort. Participants were classified into five subtypes: severe autoimmune diabetes (SAID)-like, severe insulin-deficient diabetes (SIDD)-like, severe insulin-resistant diabetes (SIRD)-like, mild obesity-related diabetes (MOD)-like, and mild age-related diabetes (MARD)-like. Comprehensive characterization included anthropometric measurements, dietary and physical activity questionnaires, blood biomarker analysis, and gut microbiota profiling.</p><p><strong>Results: </strong>The subtype distribution in the FoCus cohort accounted to SAID-like: 2.84%, SIDD-like: 30.81%, SIRD-like: 32.23%, MOD-like: 17.54%, MARD-like: 16.59%. Of interest, inflammatory markers (C-reactive protein (CRP) and Interleukin-6 (IL-6)) and glucagon-like peptide-1 (GLP-1) levels were similarly elevated across all subtypes compared to controls, indicating common aspects in Type 2 diabetes molecular pathology despite different clinical phenotypes. While the gut microbiota and dietary patterns only showed minor differences, smoking status, sleep duration, physical activity and psychological aspects varied significantly between the subtypes. In addition, we observed a lower educational status especially for SIDD-like and SIRD-like groups, which should be considered in establishing future diabetes-related patient education programs. In respect to the development of cardio-metabolic comorbidities, we observe not only significant differences in the presence of the diseases but also for their age-of onset, highlighting the need for early preventive intervention strategies.</p><p><strong>Conclusions: </strong>The study validates the ANDIS classification framework's applicability not only at the time point of manifestation but also in cohorts with pre-existing diabetes. While we did not find major differences regarding the classical metabolic, microbial and nutritional parameters, we identified several significant associations with lifestyle factors. Our findings underscore the importance of personalized, subtype-specific therapies not solely focusing on anthropometric and laboratory markers but comprehensively addressing the patient's own personality and situation of life.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"99"},"PeriodicalIF":8.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531009","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":"Insights into the complex relationship between triglyceride glucose-waist height ratio index, mean arterial pressure, and cardiovascular disease: a nationwide prospective cohort study.","authors":"Jie Xu, Dihui Cai, Yuheng Jiao, Yingying Liao, Yinyin Shen, Yunli Shen, Wei Han","doi":"10.1186/s12933-025-02657-0","DOIUrl":"10.1186/s12933-025-02657-0","url":null,"abstract":"<p><strong>Background: </strong>Both the triglyceride glucose-waist height ratio (TyG-WHtR) index and elevated arterial blood pressure are risk factors for cardiovascular disease (CVD). However, it is uncertain whether the TyG-WHtR index can increase the risk of CVD by influencing arterial blood pressure, and the extent to which the TyG-WHtR index may mediate the association between arterial blood pressure and CVD. The purpose of this study is to evaluate complex association of the TyG-WHtR index and mean arterial pressure (MAP) with CVD.</p><p><strong>Methods: </strong>All data in this study were obtained from the China Health and Retirement Longitudinal Study (CHARLS) free of CVD at baseline. CVD was defined as self-reporting heart disease and stroke. Cox proportional hazards model and restricted cubic spline (RCS) were used to analyze the association of the TyG-WHtR index and MAP with the risk of CVD. Time-dependent receiver operating characteristic (ROC) analysis was used to assess the predictive performance of TyG-WHtR, MAP for CVD. Four-way decomposition method explored the mediating effects of the TyG-WHtR index and MAP in CVD.</p><p><strong>Results: </strong>A total of 7976 participants were included in this study. The mean age of the participants was 58.68 ± 9.60 years, and 4263 (53.45%) were females. During a maximum follow-up of 7.0 years, 1326 (16.62%) people developed CVD. Both the TyG-WHtR index and MAP were signifcantly associated with CVD. The RCS regression analyses demonstrated a positive linear association of the TyG-WHtR index and MAP with the incidence of CVD. Compared with participants with TyG-WHtR < median and MAP < median, those with TyG-WHtR ≥ median and MAP ≥ median had the highest risk of CVD (HR 1.961; 95%CI 1.660-2.317). The combination of TyG-WHtR and MAP demonstrated incremental predictive utility over either biomarker alone, as evidenced by improvements in integrated discrimination improvement (IDI) and net reclassification improvement (NRI). While absolute predictive performance remained moderate. Increased MAP signifcantly mediated 52.43% of the associations between TyG-WHtR index and CVD, and increased TyG-WHtR index signifcantly mediated 83.40% of the associations between MAP and CVD.</p><p><strong>Conclusion: </strong>The combination of a higher TyG-WHtR index and a higher MAP was associated with the highest risk of CVD. The combined model of the TyG-WHtR index and MAP showed improved predictive ability, as indicated by IDI and NRI, although its overall predictive performance was still moderate. The MAP could partially mediate the association between TyG-WHtR index and CVD, as well as TyG-WHtR index could also partially mediate the association between MAP and CVD. These findings suggested that the combination of TyG-WHtR index and MAP helps identify populations at early risk of CVD and improve risk stratifcation.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"93"},"PeriodicalIF":8.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531082","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":"Relationship between atherogenic index of plasma and length of stay in critically ill patients with atherosclerotic cardiovascular disease: a retrospective cohort study and predictive modeling based on machine learning.","authors":"Yu Guo, Fuxu Wang, Shiyin Ma, Zhi Mao, Shuangmei Zhao, Liutao Sui, Chucheng Jiao, Ruogu Lu, Xiaoyan Zhu, Xudong Pan","doi":"10.1186/s12933-025-02654-3","DOIUrl":"10.1186/s12933-025-02654-3","url":null,"abstract":"<p><strong>Background: </strong>The atherogenic index of plasma (AIP) is considered an important marker of atherosclerosis and cardiovascular risk. However, its potential role in predicting length of stay (LOS), especially in patients with atherosclerotic cardiovascular disease (ASCVD), remains to be explored. We investigated the effect of AIP on hospital LOS in critically ill ASCVD patients and explored the risk factors affecting LOS in conjunction with machine learning.</p><p><strong>Methods: </strong>Using data from the Medical Information Mart for Intensive Care (MIMIC)-IV. AIP was calculated as the logarithmic ratio of TG to HDL-C, and patients were stratified into four groups based on AIP values. We investigated the association between AIP and two key clinical outcomes: ICU LOS and total hospital LOS. Multivariate logistic regression models were used to evaluate these associations, while restricted cubic spline (RCS) regressions assessed potential nonlinear relationships. Additionally, machine learning (ML) techniques, including logistic regression (LR), decision tree (DT), random forest (RF), extreme gradient boosting (XGB), and light gradient boosting machine (LGB), were applied, with the Shapley additive explanation (SHAP) method used to determine feature importance.</p><p><strong>Results: </strong>The study enrolled a total of 2423 patients with critically ill ASCVD, predominantly male (54.91%), and revealed that higher AIP values were independently associated with longer ICU and hospital stays. Specifically, for each unit increase in AIP, the odds of prolonged ICU and hospital stays were significantly higher, with adjusted odds ratios (OR) of 1.42 (95% CI, 1.11-1.81; P = 0.006) and 1.73 (95% CI, 1.34-2.24; P < 0.001), respectively. The RCS regression demonstrated a linear relationship between increasing AIP and both ICU LOS and hospital LOS. ML models, specifically LGB (ROC:0.740) and LR (ROC:0.832) demonstrated superior predictive accuracy for these endpoints, identifying AIP as a vital component of hospitalization duration.</p><p><strong>Conclusion: </strong>AIP is a significant predictor of ICU and hospital LOS in patients with critically ill ASCVD. AIP could serve as an early prognostic tool for guiding clinical decision-making and managing patient outcomes.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"95"},"PeriodicalIF":8.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531255","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 impact of metformin on kidney disease progression and mortality in diabetic patients using SGLT2 inhibitors: a real-world cohort study.","authors":"Timna Agur, Tali Steinmetz, Shira Goldman, Boris Zingerman, Dana Bielopolski, Eviatar Nesher, Ittai Fattal, Eshcar Meisel, Benaya Rozen-Zvi","doi":"10.1186/s12933-025-02643-6","DOIUrl":"10.1186/s12933-025-02643-6","url":null,"abstract":"<p><strong>Background: </strong>Selecting the optimal first-line therapy for type 2 diabetes is essential for achieving glycemic control and providing cardio-renal protection, though the combined benefits of metformin with SGLT2 inhibitors, remain uncertain.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from Clalit Health Services (2016-2021), to compare outcome in adults with type 2 diabetes treated with SGLT2 inhibitors alone versus in combination with metformin. Propensity score matching was applied to balance baseline characteristics between groups. Primary outcomes were a composite kidney outcome (40% decline in eGFR, or progression to ESRD), and all-cause mortality. Safety outcomes included hospitalizations, acute kidney injury and metabolic acidosis.</p><p><strong>Results: </strong>The study included 45,545 patients, with 6774 patients in each group following propensity score matching. The median follow-up time was 1166 days. Combination therapy with metformin and SGLT2 inhibitors was associated with significantly reduced risk of all-cause mortality (aHR 0.74, 95% CI 0.64-0.84), and composite kidney outcomes (aHR 0.65 95% CI 0.48-0.87) even after accounting for mortality as a competing risk (aHR 0.67; 95% CI 0.5-0.9). Furthermore, combination therapy was associated with reduced risks of hospitalization (aHR 0.93 95% CI 0.87-0.99), severe acute kidney injury events (aHR 0.72 95% CI 0.54-0.96) and metabolic acidosis events (aHR 0.58 95% CI 0.4-0.83), compared with SGLT2 inhibitors alone.</p><p><strong>Conclusions: </strong>Patients receiving combination therapy with metformin and SGLT2 inhibitors showed significantly reduced risks of kidney disease progression and mortality compared to those treated with SGLT2 inhibitors alone. These findings support the use of metformin with SGLT2 inhibitors as a first-line treatment strategy for type 2 diabetes irrespective of glycemic control or cardio-renal risk factors.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"97"},"PeriodicalIF":8.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531274","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}