Cardiovascular Diabetology最新文献

{"title":"Circulating mediators linking cardiometabolic diseases to HFpEF: a mediation Mendelian randomization analysis.","authors":"Mingzhi Lin, Jiuqi Guo, Hongqian Tao, Zhilin Gu, Wenyi Tang, Fuliang Zhou, Yanling Jiang, Ruyi Zhang, Dalin Jia, Yingxian Sun, Pengyu Jia","doi":"10.1186/s12933-025-02738-0","DOIUrl":"10.1186/s12933-025-02738-0","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent clinical syndrome with high morbidity and mortality. Although HFpEF frequently coexists with cardiometabolic diseases, the causal mechanisms and potential mediators remain poorly understood.</p><p><strong>Objectives: </strong>This study aimed to identify cardiometabolic risk factors specifically driving HFpEF and to determine their underlying circulating mediators.</p><p><strong>Methods: </strong>We used two-sample Mendelian Randomization (MR) to analyze the effects of obesity, Type 2 diabetes, hypertension, chronic kidney disease (CKD), and dyslipidemia on HFpEF and heart failure with reduced ejection fraction (HFrEF) in large European-ancestry GWAS datasets. We then performed mediation MR to identify plasma proteins and metabolites that mediate the transition from each cardiometabolic disease to HFpEF, respectively. We applied multivariable MR to assess the impact of risk confounding on the results. Bioinformatic analyses were conducted to delineate mechanisms.</p><p><strong>Results: </strong>Cardiometabolic diseases had heterogeneous effects on HFpEF and HFrEF. Obesity and type 2 diabetes showed adjusted causal effects with HFpEF, hypertension showed potential relevance to HFpEF, whereas dyslipidemia and CKD did not. MR analysis identified 5 proteins that mediate obesity to HFpEF; 5 proteins that mediate type 2 diabetes to HFpEF. Further mediation MR analysis of obesity and T2D on HFrEF revealed heterogeneity in circulating mediators between metabolic HFpEF and HFrEF. Comprehensive bioinformatics analyses showed that IL1R1, together with other proteins such as TP53 and FGF19, orchestrates the inflammatory and fibrotic processes underlying HFpEF.</p><p><strong>Conclusions: </strong>These findings suggest that metabolic HFpEF has distinct etiological features compared with HFrEF and is driven by complex, condition-specific mediators. IL1R1 mediates HFpEF in multiple metabolic risk states, suggesting a potential therapeutic target. Further translational studies are warranted to evaluate anti-inflammatory strategies targeting IL1R1 in HFpEF.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"201"},"PeriodicalIF":8.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961960","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 cumulative changes of the triglyceride glucose index and incidence of stroke in a population with cardiovascular-kidney-metabolic syndrome stage 0-3: a nationwide prospective cohort study.","authors":"Lifei Lu, Yubiao Chen, Baiyun Liu, Xicong Li, Jiale Wang, Zhengchang Nie, Xiaodong Fu","doi":"10.1186/s12933-025-02754-0","DOIUrl":"10.1186/s12933-025-02754-0","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index was associated with higher risk of mortality in individuals with Cardiovascular-Kidney-Metabolic (CKM) syndrome stages 0-3. However, the relationship between cumulative of TyG (cumTyG) and incidence of stroke remains unclear in individuals with CKM syndrome stages 0-3.</p><p><strong>Method: </strong>Participants with CKM syndrome stage 0-3 were enrolled from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. TyG was calculated as ln [fasting triglyceride (mg/dL)×fasting glucose (mg/dL)/2], and the cumTyG, as an area-under-the-curve estimate (mean TyG × time span), was calculated as (TyG₂₀₁₂ + TyG ₂₀₁₅)/2 * time _(2015-2012). TyG control levels were classified using k-mean clustering analysis. Logistic regression was used to analyze the effect of cumTyG and TyG control levels on the incidence of stroke. Restricted cubic spline models (RCS) were performed to explore the potential non-linear relationship between cumTyG and stroke risk at different CKM syndrome stages 0-3.</p><p><strong>Results: </strong>A total of 4,700 CKM syndrome stages 0-3 participants were enrolled, among 280 patients had developed stroke during the 3-year follow-up period. After adjusting for confounders, compared to class 1 group, the odds ratio (OR) of incidents of stroke for class 2 was 1.39 [95% confidence interval (CI) 1.003, 1.92], P = 0.046; the OR of incidents of stroke for class 3 was 1.28 (95% CI 0.92-1.77), P = 0.147, the OR of incidents of stroke for class 4 was 1.28 (95% CI 0.84-1.94), P = 0.238. Elevated cumTyG was associated with an increase in incidence of stroke (OR 1.13, 95% CI 1.05, 1.22, P = 0.002). The relationship between the cumTyG index and stroke was linear in restricted cubic spline regression.</p><p><strong>Conclusions: </strong>Elevated cumTyG was associated with an increased risk of stroke events in the population of CKM syndrome stages 0-3. Long-term dynamic monitoring of changes of TyG may help in the early identification of patients at high risk of developing stroke in the individuals with CKM syndrome stages 0-3.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"202"},"PeriodicalIF":8.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978637","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 dual-trajectories of TyG and LAP and their association with cardiometabolic multimorbidity in midlife: the CARDIA study.","authors":"Lingqu Zhou, Junjie Wang, Zirui Zhou, Liangjiao Wang, Qi Guo, Hui Zeng, Ziyue Zhong, Yinyin Zhang","doi":"10.1186/s12933-025-02761-1","DOIUrl":"10.1186/s12933-025-02761-1","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance and central obesity are major risk factors for cardiometabolic diseases. The triglyceride-glucose index (TyG) and lipid accumulation product (LAP) are markers that independently predict cardiometabolic risk. However, their combined long-term trajectories and impact on cardiometabolic multimorbidity (CMM) development remain unclear.</p><p><strong>Methods: </strong>This cohort study utilized data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which tracked 3467 participants at baseline. Dual-trajectory of TyG and LAP were identified using a group-based dual-trajectory model. Cox proportional hazards models were employed to assess the relationships between dual-trajectory groups and primary cardiometabolic outcomes, including first cardiometabolic disease (FCMD), CMM (two or more conditions such as type 2 diabetes, coronary heart disease, or stroke), and all-cause mortality. Multi-state models were performed to assess the associations of dual-trajectory with CMM development.</p><p><strong>Results: </strong>The study included 3467 participants with a mean age of 25.08 years (SD = 3.59). Of these, 43.4% (n = 1505) were male, and 53.2% (n = 1561) were White. Three distinct dual-trajectory groups were identified: low-increasing (61.5%), high-amplitude fluctuation (7.6%), and high-increasing (30.9%). After multivariate adjustment, compared with the low-increasing group, the high-amplitude fluctuation group exhibited significantly higher risks for FCMD (hazard ratio [HR] 1.38, 95% confidence interval [CI]: 1.08-1.77), CMM (HR 2.63, 95% CI 1.21-5.71), and all-cause mortality (HR 2.16, 95% CI 1.30-3.56), as well as elevated risks for transitions from baseline to FCMD (HR 1.41, 95% CI 1.17-1.63), FCMD to CMM (HR 2.07, 95% CI 1.53-3.96), CMM to death (HR 2.87, 95% CI 1.19-7.62). The high-increasing group showed similar results.</p><p><strong>Conclusions: </strong>Elevated and fluctuating trajectories of TyG and LAP from early adulthood are associated with increased risks of CMM development in midlife.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"198"},"PeriodicalIF":8.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970612","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":"Metabolic pathways mediating insulin resistance and gestational diabetes mellitus discovered by high-dimensional systematic Mendelian randomization.","authors":"Wei Chen, Mingjuan Luo, Jingyi Guo, Suna Wang, Dandan Yan, Xiaohui Feng, Yunting Huang, Tao Zeng, Li Shen, Rong Zhang, Jing Yan, Cheng Hu, Weituo Zhang, Xiangtian Yu","doi":"10.1186/s12933-025-02746-0","DOIUrl":"https://doi.org/10.1186/s12933-025-02746-0","url":null,"abstract":"<p><strong>Background: </strong>Gestational diabetes mellitus (GDM), characterized by insulin resistance (IR) and β-cell dysfunction, is one of the most common complications of pregnancy with unmet needs of prevention methods.</p><p><strong>Objective: </strong>To investigate the causal role of insulin resistance and metabolic pathways in the pathogenesis of GDM with our proposed high-dimensional systematic Mendelian randomization (hdsMR) framework.</p><p><strong>Methods: </strong>Cases with GDM and controls with normal glucose tolerance were recruited at the University of Hong Kong-Shenzhen Hospital from 2015 to 2018. A total of 566 participants (aged > 18 years), including 274 with GDM, were enrolled after excluding subjects with major chronic diseases or long-term use of medications affecting glycolipid metabolism. Clinical characteristics and serum samples were collected during the GDM screening stage, and the genome and metabolome were tested. A novel hdsMR framework was proposed to estimate the causal role of IR index (Homeostasis Model Assessment of Insulin Resistance, HOMA-IR) and metabolic pathways in the pathogenesis of GDM.</p><p><strong>Results: </strong>Our hdsMR method confirmed that HOMA-IR was causal to GDM (odds ratio, 1.17; 95% confidence interval, 1.04-1.32) and revealed that two metabolic pathways (glyoxylate and dicarboxylate metabolism pathway and lysine degradation pathway) mediated 14.6% and 8.4%, respectively, between HOMA-IR and GDM. In an independent validation cohort comprising 255 pre-diabetic individuals, we showed that both pathways could be intervened through diet (P < 0.05). Furthermore, glyoxylate and dicarboxylate metabolism pathway was significantly associated with adverse pregnancy outcomes in GDM.</p><p><strong>Conclusions: </strong>These results indicated that targeting specific metabolic pathways through dietary intervention is worth exploring as a possible GDM prevention approach, and hdsMR is more efficient in finding causal mediating metabolic pathways than traditional MR methods.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"195"},"PeriodicalIF":8.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977437","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":"Combined assessment of stress hyperglycemia ratio and glycemic variability to predict all-cause mortality in critically ill patients with atherosclerotic cardiovascular diseases across different glucose metabolic states: an observational cohort study with machine learning.","authors":"Fuxu Wang, Yu Guo, Yuru Tang, Shuangmei Zhao, Kaige Xuan, Zhi Mao, Ruogu Lu, Rongyao Hou, Xiaoyan Zhu","doi":"10.1186/s12933-025-02762-0","DOIUrl":"10.1186/s12933-025-02762-0","url":null,"abstract":"<p><strong>Background: </strong>Stress hyperglycemia ratio (SHR) and glycemic variability (GV) reflect acute glucose elevation and fluctuations, which correlate with adverse outcomes in patients with atherosclerotic cardiovascular disease (ASCVD). However, the prognostic significance of combined SHR-GV evaluation for ASCVD mortality remains unclear. This study examines associations of SHR, GV, and their synergistic effects with mortality in patients with ASCVD across different glucose metabolic states, incorporating machine learning (ML) to identify critical risk factors influencing mortality.</p><p><strong>Methods: </strong>Patients with ASCVD were screened in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and stratified into normal glucose regulation (NGR), pre-diabetes mellitus (Pre-DM), and diabetes mellitus (DM) groups based on glucose metabolic status. The primary endpoint was 28-day mortality, with 90-day mortality as the secondary outcome. SHR and GV levels were categorized into tertiles. Associations with mortality were analyzed using Kaplan-Meier(KM) curves, Cox proportional hazards models, restricted cubic splines (RCS), receiver operating characteristic (ROC) curves, landmark analyses, and subgroup analyses. Five ML algorithms were employed for mortality risk prediction, with SHapley Additive exPlanations (SHAP) applied to identify critical predictors.</p><p><strong>Results: </strong>A total of 2807 patients were included, with a median age of 71 years, and 58.78% were male. Overall, 483 (23.14%) and 608 (29.13%) patients died within 28 and 90 days of ICU admission, respectively. In NGR and Pre-DM subgroups, combined SHR-GV assessment demonstrated superior predictive performance for 28-day mortality versus SHR alone [NGR: AUC 0.688 (0.636-0.739) vs. 0.623 (0.568-0.679), P = 0.028; Pre-DM: 0.712 (0.659-0.764) vs. 0.639 (0.582-0.696), P = 0.102] and GV alone [NGR: 0.688 vs. 0.578 (0.524-0.633), P < 0.001; Pre-DM: 0.712 vs. 0.593 (0.524-0.652), P < 0.001]. Consistent findings were observed for 90-day mortality prediction. However, in the DM subgroup, combined assessment improved prediction only for 90-day mortality vs. SHR alone [AUC 0.578 (0.541-0.616) vs. 0.560 (0.520-0.599), P = 0.027], without significant advantages in other comparisons.</p><p><strong>Conclusions: </strong>Combined SHR and GV assessment serves as a critical prognostic tool for ASCVD mortality, providing enhanced predictive accuracy compared to individual metrics, particularly in NGR and Pre-DM patients. This integrated approach could inform personalized glycemic management strategies, potentially improving clinical outcomes.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"199"},"PeriodicalIF":8.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959260","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":"Life's Essential 8 cardiovascular health, cardiovascular-kidney-metabolic syndrome stages, and incident cardiovascular events: a nationwide 10-year prospective cohort study in China.","authors":"Mian Li, Min Xu, Yi Ding, Hong Lin, Guijun Qin, Tiange Wang, Yu Xu, Yuhong Chen, Shuangyuan Wang, Zhiyun Zhao, Jie Zheng, Li Yan, Lixin Shi, Zhengnan Gao, Lulu Chen, Tianshu Zeng, Ruying Hu, Zhen Ye, Xuefeng Yu, Gang Chen, Qing Su, Yiming Mu, Xulei Tang, Qin Wan, Guixia Wang, Feixia Shen, Xuejiang Gu, Zuojie Luo, Yingfen Qin, Li Chen, Xinguo Hou, Yanan Huo, Qiang Li, Hong Qiao, Yinfei Zhang, Chao Liu, Youmin Wang, Shengli Wu, Tao Yang, Huacong Deng, Jiajun Zhao, Guang Ning, Jieli Lu, Weiqing Wang, Yufang Bi","doi":"10.1186/s12933-025-02735-3","DOIUrl":"https://doi.org/10.1186/s12933-025-02735-3","url":null,"abstract":"<p><strong>Background: </strong>Definition and staging rationale of cardiovascular-kidney-metabolic syndrome were developed. The utility of cardiovascular-kidney-metabolic construct in risk stratification and target strategies of health and behavior modifications needs to be addressed. The study aims to investigate the individual and combined associations of cardiovascular-kidney-metabolic stage and cardiovascular health (CVH) by Life's Essential 8 (LE 8) with incident cardiovascular events (CVD), and determine the distribution and contribution of domain-specific CVH across cardiovascular-kidney-metabolic stages.</p><p><strong>Methods: </strong>The study included 100,727 individuals in the China Cardiovascular Disease and Cancer Cohort with complete data on cardiovascular-kidney-metabolic factors and LE 8 metrics, with a median follow-up of 10.1 years. Cardiovascular-kidney-metabolic stages and CVH metrics (nicotine exposure, diet, physical activity, sleep, body mass index, blood lipids, blood pressure, blood glucose) were defined according to Presidential Advisory from the American Heart Association. Incident CVD events including cardiovascular death, myocardial infarction, and stroke were validated. The Fine-Gray hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of CKM stages or CVH status associated with CVD.</p><p><strong>Results: </strong>Compared with cardiovascular-kidney-metabolic stage 0, the adjusted competing HRs and 95% CIs of CVD events were 1.20 (0.95-1.51), 2.45 (1.97-3.04), 4.43 (3.53-5.58), and 5.95 (4.75-7.45) from stage 1 to stage 4, respectively. Optimal CVH status and each optimal CVH metric presented a significantly decreased risk of CVD events. Variation was observed in the association between cardiovascular-kidney-metabolic stage and CVD events with different CVH status or numbers of optimal CVH metrics. Compared with those in stage 0, Participants in stage 1 or 2 with optimal CVH no longer had elevated risks for incident CVD events. Suboptimal health factor contributed larger population attributable fractions to CVD events in cardiovascular-kidney-metabolic stage 0-2 (51.2%) than in stage 3-4 (25.2%), whereas suboptimal health behavior exhibited larger contribution in advanced stages (13.1% in stage 0-2 and 18.2% in stage 3-4).</p><p><strong>Conclusions: </strong>The study indicated that cardiovascular-kidney-metabolic stage was associated with cardiovascular events, and optimal cardiovascular health could attenuate this risk. Health factor contributed predominantly at the early-stage, whereas health behavior exhibited consistent and slightly increased contribution along the spectrum. These findings support the utility of cardiovascular-kidney-metabolic construct and highlight the importance of target health improvement based on LE 8 framework.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"197"},"PeriodicalIF":8.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967773","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 association between different insulin resistance surrogates and all-cause mortality and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease.","authors":"Xin Gao, Tianyi Chen, Feilong Zhou, Yanmei Sun, Jiaqi Zhang, Xinhao Li, Weijie Zhao, Yunxin Li, Yanlong Shi, Kaiyi Niu, Yizhu Wang, Yewei Zhang, Wei Zhang","doi":"10.1186/s12933-025-02758-w","DOIUrl":"https://doi.org/10.1186/s12933-025-02758-w","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with insulin resistance (IR). However, the prognostic value of different alternative IR surrogates in patients with MASLD remains unclear. This study aimed to evaluate the association between various IR indices and all-cause mortality and cardiovascular mortality in MASLD patients.</p><p><strong>Methods: </strong>A total of 8,753 adults aged ≥ 20 years with MASLD from the National Health and Nutrition Examination Survey (NHANES, 2003-2018) were included, and their mortality data were obtained from the National Death Index (NDI). Insulin resistance surrogates [including the triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), TyG-waist circumference index, TyG-waist-to-height ratio index, and Homeostatic Model Assessment for IR] were stratified into quartiles. Cox proportional hazards models, receiver operating characteristic (ROC) curve analysis, restricted cubic spline (RCS), mediation analyses, and subgroup analyses were used to explore the associations between these indices and all-cause mortality as well as cardiovascular mortality in MASLD patients.</p><p><strong>Results: </strong>During a median follow-up of 98 months, 1,234 deaths were observed, including 409 cardiovascular disease (CVD)-related deaths. In the fully adjusted model, higher quartiles of TyG-related indices were significantly associated with an increased risk of all-cause mortality in MASLD patients. Furthermore, the TyG-BMI index was associated with both all-cause mortality and CVD mortality [all-cause mortality: HR (95% CI) 2.84 (1.73-4.67), P < 0.001; CVD mortality: HR (95% CI) 5.32 (2.26-12.49), P < 0.001]. The RCS analyses indicated a U-shaped relationship between TyG-BMI and mortality, with a threshold value of 270.49. Subgroup analyses demonstrated that TyG-related indices had stronger associations with mortality in elderly MASLD patients.</p><p><strong>Conclusions: </strong>Our findings highlight the prognostic value of IR indices, particularly TyG-BMI index, in predicting all-cause mortality and CVD mortality in MASLD patients.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"200"},"PeriodicalIF":8.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062311","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":"Effects of empagliflozin on functional capacity, LV filling pressure, and cardiac reserves in patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction: a randomized controlled open-label trial.","authors":"Artem Ovchinnikov, Alexandra Potekhina, Anastasiia Filatova, Olga Svirida, Kristina Zherebchikova, Fail Ageev, Evgeny Belyavskiy","doi":"10.1186/s12933-025-02756-y","DOIUrl":"10.1186/s12933-025-02756-y","url":null,"abstract":"<p><strong>Background: </strong>Clinical trials have established the prognostic benefits of sodium‒glucose cotransporter 2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM) and heart failure (HF) with preserved ejection fraction (HFpEF), although the underlying mechanisms are not clearly understood. The purpose of this study was to determine the effects of the SGLT2 inhibitor empagliflozin on functional capacity, left ventricular (LV) diastolic function/filling pressure, and cardiac reserves in patients with HFpEF and T2DM.</p><p><strong>Methods: </strong>In the present prospective single-center trial, we enrolled 70 diabetic patients with stable HF according to the New York Heart Association functional class II-III criteria, an LV ejection fraction ≥ 50%, and increased LV filling pressure at rest and/or during exercise (determined by echocardiography). The patients were randomly assigned in an open-label fashion to the empagliflozin group (10 mg a day, n = 35) or the control group (n = 35) for 6 months. Echocardiography (at rest and during exercise), the 6-min walk test distance (6MWD), blood levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), and the profibrotic biomarker sST2 were analysed at baseline and 6 months after randomization. The primary endpoint was the change in the 6MWD, and the secondary endpoints included the change in the left atrial (LA) volume index, early mitral inflow to mitral annulus relaxation velocity (E/e') ratio both at rest and during exercise, key cardiac reserves and biomarkers in the blood from baseline to 6 months.</p><p><strong>Results: </strong>After 6 months of empagliflozin therapy, the 6MWTD significantly increased, whereas the LA volume index and the E/e' ratio both at rest and during exercise decreased compared with those of the control group (P < 0.05 for all). LV diastolic, LA reservoir and contractile, and chronotropic reserves also improved in the empagliflozin group compared with those in the control group (P < 0.05 for all). Furthermore, treatment with empagliflozin led to improvements in NT-proBNP and ST2 blood levels compared with those in the control group (P < 0.05 for both).</p><p><strong>Conclusions: </strong>In diabetic patients with HFpEF, empagliflozin treatment improved exercise capacity, which appeared to be the result of favourable effects on LV diastolic dysfunction and key cardiac reserves: LV diastolic, LA reservoir and contractile, and chronotropic. These haemodynamic mechanisms may underline the benefits of SGLT2 inhibitors in large-scale HFpEF trials.</p><p><strong>Trial registration: </strong>URL: https://www.</p><p><strong>Clinicaltrials: </strong>gov . Unique Identifier NCT03753087.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"196"},"PeriodicalIF":8.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976945","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":"Comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular outcomes in older adults with type 2 diabetes mellitus: a target trial emulation study.","authors":"Weihong Zeng, Tiansheng Wang, Til Stürmer, Na He, Peng Shen, Hongbo Lin, Xiaodong Guan, Yang Xu","doi":"10.1186/s12933-025-02753-1","DOIUrl":"https://doi.org/10.1186/s12933-025-02753-1","url":null,"abstract":"<p><strong>Background: </strong>Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are both recommended as first-line antihypertensive agents for patients with diabetes. While pharmacological mechanisms suggest that ACEIs may provide better cardiovascular protection than ARBs, this potential benefit has not been fully established in previous observational studies of patients with diabetes.</p><p><strong>Methods: </strong>An active-comparator new-user design within target trial emulation framework was implemented using Yinzhou Regional Health Care Database (YRHCD). We compared risks of major cardiovascular events (MACE) between older patients (age ≥ 65 years) with type 2 diabetes mellitus (T2DM) newly exposed to ACEIs and ARBs from January 1, 2010 to May 31, 2023. The primary outcomes were 3-point MACE, including hospitalized myocardial infarction, hospitalized stroke, and all-cause mortality (a proxy for cardiovascular mortality). We also assessed 4-point MACE, which further included hospitalized heart failure. Propensity scores were calculated to balance 44 identified confounders. Marginal structure models were applied to estimate per-protocol hazard ratios.</p><p><strong>Results: </strong>A total of 18,558 individuals were included, with 1,641 initiating ACEIs and 16,917 initiating ARBs. Their median age was 72 years and 45% were male. The adjusted hazard ratio for ACEIs vs. ARBs was 0.86 (95% confidence interval [CI], 0.68-1.10) for 3-point MACE and 0.83 (95% CI 0.69-0.99) for 4-point MACE. The 1-year absolute risk differences were - 0.30% (95% CI - 1.80-1.21%) for 3-point MACE and - 1.16% (95% CI - 2.97-0.66%) for 4-point MACE. Results were consistent across subgroup analyses (stratified by age, sex, as well as baseline major atherosclerotic cardiovascular disease, heart failure, other antihypertensive therapy, insulin therapy, and calendar year) and sensitivity analyses.</p><p><strong>Conclusions: </strong>Among older patients with T2DM, the initiation of ACEIs was associated with a trend toward lower risk of MACE compared to ARBs, implying the potential cardiovascular benefits of ACEIs in this population.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"194"},"PeriodicalIF":8.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967772","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":"Correction: Visceral adipose tissue mediates the relationship between left ventricular global longitudinal strain and insulin resistance among adults living with type 2 diabetes.","authors":"Pavel Martinez-Dominguez, Paola Gomez-Aviles, Kenya Bautista-García, Neftali Eduardo Antonio-Villa, Enrique C Guerra, Paloma Almeda-Valdes, Alexandro J Martagón, Alejandro Campos Munoz, Maria Jose Santa-Ana-Bayona, Erick Alexanderson, Carlos A Aguilar Salinas, Nilda Espinola-Zavaleta","doi":"10.1186/s12933-025-02727-3","DOIUrl":"https://doi.org/10.1186/s12933-025-02727-3","url":null,"abstract":"","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"24 1","pages":"191"},"PeriodicalIF":8.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974162","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}