Cardiovascular Diabetology最新文献

{"title":"Exercise modalities and dosages on glycated haemoglobin and exerkines in type 2 diabetes: a systematic review with pairwise, network, and dose-response meta-analyses.","authors":"Li-Bing Liang, Zhi-Hao Zhao, Wen-Xuan Li, Shan Wang, Qun-Song Shen, Cai-Qin Wu, Kun-Peng Li","doi":"10.1186/s12933-026-03236-7","DOIUrl":"10.1186/s12933-026-03236-7","url":null,"abstract":"<p><strong>Background: </strong>Exercise is a cornerstone of type 2 diabetes mellitus (T2DM) management; however, the comparative efficacy of specific modalities, optimal dosages, and associated exerkine responses remains incompletely defined. This study aimed to synthesise evidence on the effects of different exercise types and doses on glycated haemoglobin (HbA1c) levels and to explore modality-specific patterns of exerkine regulation in adults with T2DM.</p><p><strong>Methods: </strong>A systematic review and Bayesian evidence synthesis of randomised controlled trials was conducted up to October 2025. Pairwise, network, and model-based dose-response meta-analyses were employed to evaluate the effects of eight exercise modalities on HbA1c levels. Exploratory analyses were performed to evaluate changes in circulating adiponectin, brain-derived neurotrophic factor (BDNF), interleukin-6, leptin, resistin, and tumour necrosis factor-α levels.</p><p><strong>Results: </strong>A total of 127 trials involving 8,744 participants were included. Network meta-analysis ranked combined mind-body resistance training (tai chi + elastic bands) and high-intensity interval training (HIIT) as the most effective modalities for reducing the level of HbA1c (surface under the cumulative ranking curve: 85.9% and 78.6%, respectively). An L-shaped nonlinear dose-response relationship was observed, with the majority of the clinical benefit being achieved at 600 MET-min/week (mean difference: -0.57%; 95% credible interval: -0.72, -0.42) and a plateau beyond approximately 1,000 MET-min/week. Exploratory exerkine analyses suggested modality-specific signatures; specifically, HIIT was associated with greater increases in adiponectin levels, whereas resistance-based interventions trended towards greater reductions in interleukin-6 and tumour necrosis factor-α levels. In pairwise comparisons versus the control, no significant overall changes were detected for adiponectin, BDNF, interleukin-6, or resistin.</p><p><strong>Conclusion: </strong>In adults with T2DM, exercise efficacy varies by modality and follows a dose-plateau pattern. The achievement of 600 MET-min/week produces a meaningful reduction in HbA1c levels, with diminishing returns being observed beyond approximately 1,000 MET-min/week. MBRT and HIIT are the most promising modalities, although the evidence concerning MBRT remains preliminary in nature. Modality-specific exerkine patterns were observed; specifically, HIIT ranked highest for adiponectin, whereas RT ranked highest for IL-6 and TNF-α. These findings inform evidence-based, personalised exercise prescription in T2DM patients.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270626","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":"Cardioprotective glucose-lowering drugs, statins, and secondary major adverse cardiovascular events: a nationwide cohort study of individuals with type 2 diabetes and cardiovascular disease.","authors":"Tummas Ternhamar, Mia Ø Johansen, Børge G Nordestgaard, Shoaib Afzal","doi":"10.1186/s12933-026-03242-9","DOIUrl":"10.1186/s12933-026-03242-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In type 2 diabetes, cardioprotective glucose-lowering drugs, including sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, and statins reduce the risk of secondary major adverse cardiovascular events. No trials examined the combination of these drugs as withholding statins in high-risk individuals would be unethical. We tested the hypothesis that cardioprotective glucose-lowering drug and statin combined is associated with lower risk of secondary major adverse cardiovascular events than either drug alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Individuals with type 2 diabetes and established cardiovascular disease from December 2012 through 2021 were identified via national Danish health registers. They were analyzed in an active comparator cohort including 15,404 individuals followed from treatment intensification with cardioprotective glucose-lowering drug or dipeptidyl peptidase-4 inhibitor and additionally in a time-varying cohort including 76,853 individuals with yearly updated treatment and covariate status. The treatment groups were: (i) no cardioprotective drug (no use of cardioprotective glucose-lowering drug or statin), (ii) cardioprotective glucose-lowering drug, (iii) statin, and (iv) cardioprotective glucose-lowering drug and statin. The primary outcome was a new major adverse cardiovascular event (myocardial infarction, stroke, or cardiovascular death).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During mean 2.7 and 4.7 years of follow-up, 1,843 and 23,051 had major adverse cardiovascular events in the active comparator and time-varying cohorts. In the active comparator cohort, when compared to nonusers of cardioprotective glucose-lowering drug or statin, multivariable adjusted hazard ratios of major adverse cardiovascular events were 0.82 (95% confidence interval: 0.67 to 1.02) for cardioprotective glucose-lowering drug, 0.85 (0.74 to 0.97) for statin, and 0.71 (0.60 to 0.84) for cardioprotective glucose-lowering drug and statin combined. Corresponding hazard ratios in the time-varying cohort were 0.77 (0.69 to 0.86), 0.73 (0.70 to 0.75), and 0.57 (0.54 to 0.60), respectively. When restricting the active comparator cohort to individuals entering observation between 2019 and 2021 with reduced statistical power, the corresponding hazard ratios were 0.86 (0.57 to 1.31), 0.89 (0.60 to 1.30), and 0.79 (0.54 to 1.14), respectively. In both cohorts p for interaction between cardioprotective glucose-lowering drug and statin was &gt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In individuals with type 2 diabetes and established cardiovascular disease, treatment with a cardioprotective glucose-lowering drug and statin in combination was associated with lower risk of secondary major adverse cardiovascular events than using either drug alone. This is important given the persistently suboptimal uptake of both drug classes in real-world practice. Some biases can never be completely exclu","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263488","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":"Chamber-specific cardiac proteome remodeling in a Göttingen minipig model of obesity and diabetes.","authors":"Samantha Gallero, Christian T Voldstedlund, Simone Krog, Trine Pagh Ludvigsen, Lisbeth Høier Olsen, Thomas E Jensen","doi":"10.1186/s12933-026-03250-9","DOIUrl":"10.1186/s12933-026-03250-9","url":null,"abstract":"<p><strong>Background: </strong>Obesity and Type 2 Diabetes are major contributors to cardiac hypertrophy and dysfunction, yet the molecular mechanisms driving early myocardial alterations remain incompletely understood. Evidence from rodent models and end-stage human disease suggests that cytoskeletal remodeling and oxidative stress may contribute to early increases in cardiomyocyte stiffness and hypertrophy. Whether these processes are involved at earlier disease stages in translationally relevant large-animal models remains unclear.</p><p><strong>Methods: </strong>Heart tissue from male Göttingen minipigs subjected to a 13-month intervention with a standard control diet, high-fat-fructose-cholesterol diet, or high-fat-fructose-cholesterol with streptozotocin-induced diabetes was analyzed. Untargeted proteomics was performed on left atrium and left ventricle tissue, followed by pathway enrichment analyses to identify diet- and chamber-specific proteomic alterations.</p><p><strong>Results: </strong>Global proteomic analyses revealed that anatomical region represented the dominant source of variance, with ~ 200-300 proteins significantly regulated across dietary interventions. Pathway enrichment analyses highlighted alterations in protein and macronutrient metabolism, mitochondrial function, and extracellular matrix organization. Correlation and Hallmark analyses further linked ventricular remodeling to glucose-associated and mitochondrial pathways, while atrial remodeling was more closely associated with metabolic and nutrient-sensing pathways. Among 75 microtubule and 53 redox-related proteins examined, 16 and 14, respectively, were significantly altered in a chamber- and intervention-dependent manner.</p><p><strong>Conclusion: </strong>Early cardiac hypertrophy associated with obesity and/or diabetes is accompanied by extensive proteomic remodeling, characterized by distinct atrial and ventricular profiles. However, the relatively modest changes in microtubule and redox-related proteins suggest that these are unlikely to be primary drivers of early myocardial remodeling.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263475","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":"Integration of triglyceride-glucose index and biological aging to predict cardiovascular disease risk in cardiovascular-kidney-metabolic syndrome stages 0-3: a multiple prospective cohort study.","authors":"Runnan Shen, Pinrong Dong, Shuxiang Fang, Zirui Jia, Ayiguli Abudukeremu, Jiexin Li, Kai Huang, Xiaoqin Zuo, Yixuan Ma, Yilin Liu, Kai Huang, Yangxin Chen","doi":"10.1186/s12933-026-03192-2","DOIUrl":"10.1186/s12933-026-03192-2","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index serves as a surrogate marker of insulin resistance and reflects underlying metabolic dysfunction, while biological aging (KDM-BA) independently contributes to cardiovascular vulnerability. However, no study has attempted to integrate metabolic dysfunction and biological aging to improve cardiovascular disease (CVD) risk prediction in individuals with cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3.</p><p><strong>Methods: </strong>Multiple prospective cohorts were used, including 286,864 participants from the UK Biobank (UKB), 7237 from the China Health and Retirement Longitudinal Study (CHARLS), and 517 from Sun Yat-sen Memorial Hospital, Sun Yat-sen University, which were further included for external validation of the primary outcome. TyG-KDM-BA was calculated by multiplying the TyG index by KDM-BA. Cox proportional hazards models were used to evaluate the association. Time-dependent receiver operating characteristic (ROC) curves, as well as analyses of incremental predictive value, sensitivity analyses, and external validation were conducted to evaluate predictive performance.</p><p><strong>Results: </strong>During a median follow-up of 15.27 years in UKB, 57,896 incident CVD events occurred (cumulative incidence: 20.18%). During a median follow-up of 7.84 years in CHARLS cohort, 1,610 incident CVD events were observed (cumulative incidence: 22.25%). CVD risk increased progressively across TyG-KDM-BA quartiles in both cohorts. In the fully adjusted model, each 1-SD increase in TyG-KDM-BA was associated with higher CVD risk in both cohorts (UKB: HR = 1.65, 95% CI 1.64-1.67; CHARLS: HR = 1.25, 95% CI 1.18-1.32). Participants in the highest quartile had significantly higher CVD risk than those in the lowest (UKB: HR = 3.97, 95% CI 3.86-4.09; CHARLS: HR = 1.92, 95% CI 1.63-2.25). TyG-KDM-BA was positively associated with CHD and stroke risk in both cohorts. Compared with conventional TyG-derived indices, TyG-KDM-BA achieved higher discrimination for CVD risk prediction, with an area under the curve of 0.657-0.659 over 5-15 years in UKB and moderate, consistent performance in CHARLS. Incremental analyses demonstrated that TyG-KDM-BA provided additional predictive value beyond conventional models and its individual components. External validation analyses supported the robustness of results.</p><p><strong>Conclusion: </strong>TyG-KDM-BA integrates metabolic and aging dimensions, demonstrating superior predictive ability for CVD risk among individuals with CKM stages 0-3 compared to traditional TyG-derived indicators, and may serve as a more effective tool for the early screening and intervention.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263466","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":"Prognostic Value of Coronary CT Angiography Among Patients With and Without Diabetes: The Mass General Brigham CCTA registry.","authors":"Arthur Shiyovich, Daniel M Huck, Rhanderson Cardoso, Adam N Berman, Stephanie A Besser, David W Biery, Milena Petranovic, Brittany N Weber, Jon Hainer, Camila V Blair, Nandini M Meyersohn, Avinainder Singh, Vinit Baliyan, Michael T Lu, Michael Steigner, Ayaz Aghayev, Khurram Nasir, Christopher P Cannon, Sandeep Hedgire, Marcelo Di Carli, Brian Ghoshhajra, Ron Blankstein","doi":"10.1186/s12933-026-03193-1","DOIUrl":"10.1186/s12933-026-03193-1","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the relationship between coronary CT angiography detected coronary artery disease (CAD) and long-term cardiovascular outcomes among individuals with and without diabetes mellitus (DM).</p><p><strong>Methods: </strong>A retrospective cohort study of patients undergoing CCTA at two medical centers between 2006 and 2024. Patients with prior CAD, advanced kidney disease, or malignancy were excluded. DM was defined by diagnostic codes or elevated hemoglobin A1c. CCTA findings were categorized as no CAD, nonobstructive CAD (1-49% stenosis), or obstructive CAD (≥ 50% stenosis). The primary outcome was a composite of cardiovascular death (CVD) or myocardial infarction (MI).</p><p><strong>Results: </strong>Among 22,377 patients (median age 56 [IQR 47-65]; 45% women), 3,245 (14.5%) had diabetes. Individuals with diabetes were older and had more cardiovascular risk factors. Obstructive CAD was more frequent in patients with diabetes (33% vs. 19%), whereas no CAD was less common (23% vs. 42%). Over a median follow-up of 6 years (IQR 3.9-9.5), the primary outcome occurred more than twice as often among those with diabetes (7.8% vs. 3.1%; P < 0.001). Event rates increased with CAD severity and remained higher among individuals with diabetes across all categories. After adjustment, obstructive CAD remained significantly associated with the primary outcome in both groups (DM: HR 2.9 [95% CI 1.8-4.6], P < 0.001; non-DM: HR 2.7 [95% CI 2.1-3.4]), p < 0.001).</p><p><strong>Conclusions: </strong>Among patients undergoing CCTA, CAD was more frequent and severe in those with diabetes, and the risk of CVD or MI increased with CAD severity, approximately doubling in each category when diabetes was present.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257846","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":"Head-to-head comparison of fasting-insulin-based versus non-insulin-based insulin resistance surrogates for predicting all-cause and cardiovascular mortality in hypertensive adults across the glycemic continuum: a prospective cohort study.","authors":"Fuad A Abdu, Abdul-Quddus Mohammed, Wen Zhang, Jiasuer Alifu, Lu Liu, Guoqing Yin, Yiteng Liao, Guofu Zhu, Wenliang Che","doi":"10.1186/s12933-026-03244-7","DOIUrl":"10.1186/s12933-026-03244-7","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance (IR) is mechanistically linked to hypertension, yet no study has directly compared fasting-insulin-based and non-insulin-based IR surrogates for predicting mortality across the glycemic spectrum in hypertensive adults. We evaluated ten IR indices, three insulin-based [homeostasis model assessment of insulin resistance (HOMA-IR), McAuley index, and quantitative insulin sensitivity check index (QUICKI)] and seven non-insulin-based [triglyceride-glucose index (TyG), stress hyperglycemia ratio (SHR), cardiometabolic index (CMI), atherogenic index of plasma (AIP), estimated glucose disposal rate (eGDR), metabolic score for insulin resistance (METS-IR), and lipid accumulation product (LAP)], for all-cause mortality (ACM) and cardiovascular mortality (CVM) by glycemic status.</p><p><strong>Methods: </strong>This prospective cohort study included 7,548 hypertensive adults from NHANES 1999-2018, classified as normoglycemia (n = 1,869), prediabetes (n = 3,389), and diabetes (n = 2,290). Mortality data were collected through December 31, 2019. Associations were analyzed using Cox models with three levels of adjustment. Dose-response relationships were modeled with restricted cubic splines.</p><p><strong>Results: </strong>Over a mean follow-up of 8.7 ± 5.3 years, 1,752 ACM events (23.2%) and 499 CVM events (6.6%) occurred. In fully adjusted models, HOMA-IR independently predicted ACM (per-unit HR 1.017; Q4 HR 1.165) and CVM (per-unit HR 1.012). eGDR showed the strongest overall associations: ACM: per-unit HR 0.807; Q4 HR 0.559; CVM: per-unit HR 0.774; Q4 HR 0.538. TyG predicted ACM (per-unit HR 1.158; Q4 HR 1.233) and CVM per-unit (HR 1.160). In glycemic-stratified analyses, HOMA-IR was the only index with per-unit ACM significance across all three strata (normoglycemia: HR 1.085; prediabetes: HR 1.039; diabetes: HR 1.012). eGDR showed per-unit and Q4 ACM significance in prediabetes and diabetes, and demonstrated significant quartile-level protection for CVM in both prediabetes (Q4 HR 0.465) and diabetes (Q4 HR 0.463), whereas per-unit associations with CVM were observed only in diabetes. TyG was significantly associated with ACM in diabetes (per-unit HR 1.147; Q4 HR 1.337) and with CVM in diabetes (Q4 HR 1.595).</p><p><strong>Conclusions: </strong>In hypertensive adults, HOMA-IR was the only fasting-insulin-based index independently associated with ACM across all three glycemic strata. eGDR demonstrated the most consistent non-insulin-based associations with ACM and CVM, particularly in prediabetes and diabetes. TyG provided additional prognostic value for ACM and CVM, particularly in patients with diabetes. These findings support selecting IR indices based on glycemic phenotype and data availability.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257710","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 the atherogenic index of plasma and its modified indices with the incidence and progression of cardiometabolic multimorbidity in individuals with cardiovascular-kidney-metabolic syndrome stages 0-3: a prospective cohort study.","authors":"Fei Xue, Qingmei Han, Yifei Li, Cheng Cheng, Lin Xie, Jianmin Yang, Jiye Wan","doi":"10.1186/s12933-026-03255-4","DOIUrl":"10.1186/s12933-026-03255-4","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 reflect a heterogeneous continuum of metabolic, kidney, and cardiovascular abnormalities that are closely associated with the development of cardiometabolic diseases (CMDs). Although the atherogenic index of plasma (AIP) and obesity-related composite indices have been associated with individual CMDs, their associations with cardiometabolic multimorbidity (CMM) among individuals with CKM syndrome remain unclear. This study primarily investigated whether AIP-related indices were associated with the incidence and progression of CMM in individuals with CKM syndrome stages 0-3.</p><p><strong>Methods: </strong>This prospective cohort study included 346,868 UK Biobank participants without baseline type 2 diabetes (T2DM), coronary heart disease (CHD), or stroke. CMM was defined as the coexistence of at least two of these conditions. Cox proportional hazards models were used to estimate associations with incident CMM, while multistate models were applied to characterize disease progression. As secondary analyses, the added predictive value of each index was assessed using discrimination and reclassification metrics. Exploratory biomarker analyses examined whether inflammatory, liver, and renal biomarkers statistically accounted for part of the associations.</p><p><strong>Results: </strong>During a median follow-up of 15.9 years, 8573 participants developed CMM. All eight AIP-related indices were positively associated with incident CMM, with hazard ratios per 1-SD increment ranging from 1.12 to 1.37 (all P < 0.001). Multistate analyses suggested stage-specific associations during CMM progression, with stronger associations observed for the transition from baseline to T2DM and from single CMD to CMM involving CHD (all P < 0.001). In secondary prediction analyses, adding each index to conventional risk factors improved discrimination and reclassification, with the AIP-body roundness index (AIP-BRI) showing the greatest overall incremental predictive value. Exploratory biomarker analyses indicated that inflammatory, liver, and renal biomarkers jointly accounted for 32.5-46.4% of the associations, although these findings should not be interpreted as evidence of causal mediation.</p><p><strong>Conclusion: </strong>Among individuals with CKM syndrome stages 0-3, AIP-related indices were positively associated with the incidence and progression of CMM, supporting their potential utility for CMM risk stratification within the CKM framework. These indices, particularly AIP-BRI, may provide additional predictive information. Exploratory biomarker findings might provide preliminary clues for future mechanistic research.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249412","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":"Gestational diabetes as an inter-generational cardiometabolic risk factor: spotlight on emerging exerkines.","authors":"Pamela Senesi, Livio Luzi, Andrea Sonaglioni, Flavia Alberti, Elisa Cipponeri, Anna Ferrulli","doi":"10.1186/s12933-026-03247-4","DOIUrl":"10.1186/s12933-026-03247-4","url":null,"abstract":"<p><p>Gestational diabetes mellitus (GDM) is an increasingly prevalent global health condition, driven by rising maternal age and the obesogenic environment, currently affecting approximately 14% of pregnancies worldwide. GDM is associated with adverse perinatal outcomes as well as a substantial increase in long-term cardiometabolic risk. Women with a history of GDM exhibit a markedly elevated risk of developing type 2 diabetes (T2D) within the first decade postpartum, together with an approximately twofold higher risk of major cardiovascular events. Importantly, offspring of mothers with GDM are also predisposed to obesity and T2D later in life, underscoring the role of GDM as a major intergenerational determinant of cardiometabolic disease. Physical activity is recommended as an effective non-pharmacological strategy for the prevention and management of GDM; however, the molecular mechanisms underlying its benefits remain only partially understood. Exerkines, bioactive molecules modulated by exercise, have emerged as important regulators of systemic metabolic and cardiovascular adaptations. In addition to the well-characterised exerkines such as leptin, adiponectin, and irisin, emerging evidence supports the relevance of additional mediators, including chemerin, members of the FGF19 subfamily, and adipsin, as contributors to the pathophysiology of GDM and cardiovascular risk. This narrative review summarises the current evidence on these emerging exerkines, focusing on their biological mechanisms and clinical relevance in GDM. A deeper understanding of the exerkine network may provide novel insights into the interplay between exercise, metabolic regulation, and pregnancy, ultimately supporting improved GDM management and long-term cardiometabolic risk stratification across generations.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249141","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":"Perivascular adipokine signaling in abdominal aortic aneurysm: cardiometabolic drivers of vascular remodeling and translational opportunities.","authors":"Xinyi Zhang, Hanxun He, Hang He, Yujin Zhang, Yuxiao Zhang, Yufan Zhou, Xiaofan Huang, Jiaqi Huang, Ping Ye, Jiahong Xia","doi":"10.1186/s12933-026-03254-5","DOIUrl":"10.1186/s12933-026-03254-5","url":null,"abstract":"<p><p>Abdominal aortic aneurysm (AAA) represents a significant vascular pathology characterized by high mortality rates and a paucity of effective pharmacological interventions. Recent research underscores the role of perivascular adipose tissue derived adipokines in establishing a direct connection between obesity and the pathogenesis of AAA. These adipokines exert influence on aneurysmal remodeling by modulating the functions of vascular cells, particularly in relation to inflammation and extracellular matrix degradation. They can be categorized into two broad classes: deleterious (pro-aneurysmal) and protective (anti-aneurysmal). Deleterious adipokines exacerbate AAA through the promotion of inflammation, the weakening of the vascular wall, and the stimulation of aberrant vascular growth. In contrast, protective adipokines contribute to the attenuation of AAA progression via antioxidative, anti-inflammatory, and vascular homeostatic mechanisms. Recent evidence indicates that restoring adipokine balance may serve as a promising therapeutic approach for AAA. Although the majority of studies are still in the preclinical stage, the repurposing of metabolic drugs such as GLP-1 receptor agonists, metformin, and PPAR agonists has shown potential in rebalancing adipokine profiles, reducing inflammation, and promoting vascular repair. Additionally, novel agents targeting adipokine receptors, including adiponectin agonists, chemerin antagonists, and FABP4 inhibitors, have demonstrated preliminary efficacy in modulating adipokine signaling and mitigating vascular inflammation. This review synthesizes the mechanistic roles of adipokines in AAA, with a focus on therapeutic opportunities targeting adipokine driven pathways, and outlines a framework for future translational and clinical research aimed at adipokine-based management of AAA.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of fat-to-muscle mass ratio with incident coronary artery disease and the potential role of metabolic signatures.","authors":"Kaibo Hu, Yanjun Song, Zhangyu Lin, Zechen Liu, Hao Wang, Kefei Dou","doi":"10.1186/s12933-026-03251-8","DOIUrl":"10.1186/s12933-026-03251-8","url":null,"abstract":"<p><strong>Background: </strong>The fat-to-muscle mass ratio (FMR) reflects the balance between metabolic burden and capacity. However, the associations of total and regional FMR with incident coronary artery disease (CAD) and their underlying metabolic mechanisms remain unclear.</p><p><strong>Methods: </strong>We included 398,435 UK Biobank participants free of baseline cardiovascular disease, diabetes, or lipid-lowering therapy. Total and regional (trunk, arm, leg) FMR were quantified via bioelectrical impedance analysis. Participants were stratified by sex and classified based on FMR thresholds derived from restricted cubic splines and BMI categories. Primary outcome was incident CAD, defined as myocardial infarction, coronary revascularization, or CAD mortality. Metabolic signatures were constructed using elastic net regression on 251 NMR metabolites.</p><p><strong>Results: </strong>During a median follow-up of 12.61 years, 10,740 incident CAD cases were documented. Higher total and regional FMR were significantly associated with increased CAD risk in both sexes. Leg FMR exhibited the strongest independent association; after mutual adjustment for BMI, it remained a significant predictor in both women (HR: 3.672, 95% CI 1.958-6.887) and men (HR: 2.682, 95% CI 1.682-4.275), whereas associations for other FMR types were attenuated. Mediation analysis suggested that metabolic signatures partially accounted for the association between FMR and CAD, explaining over 70% of the statistical effect. Furthermore, adding leg FMR to standard risk factors significantly improved risk reclassification (NRI: 0.142 for women, 0.081 for men; both p value < 0.001).</p><p><strong>Conclusions: </strong>Elevated FMR, particularly leg FMR, is strongly associated with higher CAD risk independent of BMI. These findings suggest that altered body composition may reflect underlying metabolic dysregulations, and assessing leg FMR could provide additive value for risk reclassification, particularly in women.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":" ","pages":""},"PeriodicalIF":15.6,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249389","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}