Sex differences in cardiometabolic disorders

Sex differences in pulmonary arterial hypertension: Insights from the FOCUS-PAH registry

BACKGROUND

Despite the higher incidence of pulmonary arterial hypertension (PAH) in women, sex differences in terms of clinical presentation and prognosis are still uncertain. We assess the impact of sex in patients with PAH.

METHODS

Sex differences were evaluated in the multicenter FOCUS-PAH registry, that included patients diagnosed with PAH at 7 tertiary care centers between 2001 and 2022. Patients' characteristics and outcomes were compared in men vs. women, and factors independently associated with long-term outcomes were assessed. The primary endpoint was overall survival.

RESULTS

Among 410 included patients, 273 (66.6 %) were women and 137 (33.4 %) were men. Despite similar age, men had more cardio-renal-metabolic comorbidities and history of HIV infection, whereas women had more connective tissue disorders and scleroderma, and worse functional capacity. Dual therapy was more commonly prescribed in women (39.9 % vs. 27.0 %). At multivariable Cox regression analysis, female sex was independently associated with a lower risk of all-cause mortality (adjusted hazard ratio 0.60, 95 % confidence interval 0.38-0.95, p = 0.031). Age, European Society of Cardiology (ESC) / European Respiratory Society (ERS) risk score, glomerular filtration rate and scleroderma were independently associated with long-term mortality in women, whereas only age and ESC/ERS risk score independently predicted this endpoint in men.

CONCLUSIONS

In this real-world registry, women represented 2 out of 3 patients with PAH and female sex was independently associated with a lower risk of mortality. There were differences in the variables associated with long-term mortality between sexes, suggesting that individualized approach to risk stratification should also include sex.

Sex and clinical outcomes in new-onset heart failure

BACKGROUND

Sex differences in heart failure (HF) presentation, management, and outcomes have been described, but data in new-onset acute HF are scarce. Our aim was to examine sex influence in clinical characteristics, treatment, and prognosis of patients admitted with new-onset HF.

METHODS

The Spanish Network for the Study of Heart Failure III (REDINSCOR III) is a prospective registry that included consecutive adults admitted with new-onset acute HF. The primary outcome was 12-month mortality, with additional analyses on HF readmissions.

RESULTS

The registry included 532 patients, 178 females (33.4 %). Compared to men, women were older (mean age 71.2 ± 13.1 vs. 65.7 ± 13.0 years, P < 0.001), more likely to live alone (24.9 % vs. 12.1 %, P = 0.001), and presented higher left ventricular ejection fraction (43.4 ± 15.2 % vs. 37.2 ± 13.6 %, P < 0.001), lower prevalence of prior cardiovascular disease, including myocardial infarction (15.0 % vs. 5.7 %, P = 0.002) and peripheral arterial disease (8.0 % vs. 2.3 %, P = 0.010). A total of 30 patients died during follow-up (5,6 %), mortality was similar in women and men (10 [5.6 %] vs. 20 [5.7 %], P = 0.988). Female sex was not independently associated with all-cause mortality (hazard ratio [HR]: 0.77, 95 % confidence interval [CI]: 0.34-1.74, P = 0.540), HF readmissions (HR: 1.29, 95 % CI: 0.66-2.53, P = 0.451), nor the combined outcome death/HF readmission (HR: 0.98, 95 % CI: 0.56-1.74, P = 0.972). All-cause mortality increased with age (HR: 4.32, 95 % CI: 1.72-10.81, P = 0.002) and was also influenced by hemoglobin levels (HR: 0.98, 95 % CI: 0.96-0.99, P = 0.006).

CONCLUSION

Sex does not seem to influence the prognosis of new-onset HF.

Independent and Combined Associations of Physical Activity and Screen Time With Biomarkers of Inflammation in Children and Adolescents With Overweight/Obesity

PURPOSE

Inflammation regulation is important for obesity management and prevention of obesity-related diseases. This cross-sectional study aimed to analyze the independent and combined associations of physical activity and screen time with biomarkers of inflammation in children and adolescents with overweight/obesity.

METHOD

A total of 1289 children and adolescents with overweight/obesity were included from the 2015 to 2018 National Health and Nutrition Examination Survey. Multivariable linear regressions were conducted for the association analyses.

RESULTS

For the independent associations, a negative dose-dependent relationship was demonstrated between physical activity and inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) in adolescents with overweight/obesity (P < .001) but not children; screen time was not associated with hsCRP in both children and adolescents. No significant association was found between physical activity or screen time with other inflammatory biomarkers. For the combined associations, there was an interaction between physical activity and screen time on hsCRP in adolescents with overweight/obesity (P = .014). In addition, the negative association between physical activity and hsCRP was greater in boys compared with girls and in Hispanic and non-Hispanic Black individuals compared with non-Hispanic White individuals.

CONCLUSION

This study demonstrated a combined association of physical activity and screen time with inflammatory biomarker hsCRP in adolescents with overweight/obesity.

Cardiometabolic disease management: influences from epigenetics

Epigenomics is a rapidly emerging field that has gathered significant attention as a "non-genetic determinant" implicated in the manifestation of non-communicable diseases. Exploring epigenetic modifications provides novel insights into the management of cardiometabolic disease (CMD). Epigenetics signatures are influenced by environmental stressors such as air pollution, toxins, and urban noises as well as by established cardiovascular risk factors including smoking, sedentary lifestyle, obesity, and diabetes. Understanding how epigenetic alterations lead to CMD as well as inter-individual differences in epigenetic makeup could unveil new molecular targets and new epi-drugs to be employed for precision medicine approaches in the growing population of patients with cardiometabolic disease to reduce cardiovascular risk. Herein, we provide an overview of the latest advancements in epigenetic mechanisms implicated in CMD and possible therapeutic opportunities.

Association between diabetes phenotypes with hypertension and cardiovascular diseases, using single-sample confirmatory testing: a national study

AIM

To investigate, for the first time, the association between undiagnosed diabetes-using a single-sample confirmatory definition-and prevalent hypertension and cardiovascular diseases (CVD) in an Iranian national population. A few studies on this topic have been limited to Western populations.

METHODS

The study included 16328 adults aged ≥ 30 years. Diabetes phenotypes were classified as: 1-no diabetes: fasting plasma glucose (FPG) < 7 mmol/L (126 mg/dL) and glycated hemoglobin (HbA1c) < 6.5% (48 mmol/mol), as reference; 2-unconfirmed undiagnosed diabetes: having elevated levels of either FPG or HbA1c; 3-confirmed undiagnosed diabetes: having elevated levels of both tests; 4-known diabetes: self-reported history of glucose-lowering medications. Hypertension was defined using American Heart Association criteria. Self-reported history of CVD is defined as prevalent CVD. Multivariable logistic regression models were applied to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between diabetes phenotypes with hypertension and CVD.

RESULTS

Prevalence of unconfirmed undiagnosed-, confirmed undiagnosed-, and known -diabetes was calculated as 2.70, 3.10, and 5.64%, respectively. Unconfirmed undiagnosed-, confirmed undiagnosed-, and known -diabetes were associated with hypertension with corresponding OR were, 1.30, 1.37, and 1.62; the related values for CVD were 1.80, 1.61, and 2.38; and for the coexistence of CVD and hypertension were 1.86, 1.79, and 2.80, respectively (all P values < 0.05). Furthermore, isolated HbA1c elevation was significantly associated with prevalent CVD [2.04 (1.20-3.45)], and coexistence of hypertension and CVD [1.89 (1.00-3.55)].

CONCLUSIONS

Both unconfirmed- and confirmed- undiagnosed -diabetes were significantly associated with hypertension and CVD, the issue that was mainly attributable to high HbA1c.

Obesity, composite dietary antioxidant index, and their interactive association with the risk of cardiometabolic multimorbidity in the elderly from a large national survey

BACKGROUND

Dietary antioxidants and obesity are considered significant targets for disease prevention in the elderly. However, a possible cardiometabolic multimorbidity (CMM) correlated to dietary antioxidants and obesity is unknown. This study aimed to examine the relationship between dietary antioxidants and obesity with CMM in the older population.

METHODS

We used data from the NHANES 2003-2018 cycles, including older adults aged 60 and above. Dietary antioxidant status was assessed using the CDAI, calculated from six micronutrients (vitamins A, C, E, selenium, zinc, and carotenoids), and obesity was classified based on BMI. We applied restricted cubic spline models to explore nonlinear associations and logistic regression to assess the associations between pro-oxidant diet, obesity, and CMM. The joint effects of pro-oxidant diet and obesity on CMM were evaluated using additive interaction indices: RERI, AP, and SI, to determine the synergistic impact of these factors. Subgroup analyses by age, sex, ethnicity, and hypertension status were also conducted to assess the synergistic effect of these factors within different population groups.

RESULTS

A total of 13,178 older adults (mean age 69.85 ± 0.10 years; 45.1% male) were included in this study. A pro-oxidant diet and obesity jointly increased CMM risk, with the Pro-oxidant diet & Obese group having the highest risk (adjusted OR 3.11, 95% CI: 2.39-4.04), indicating that their likelihood of CMM was more than three times higher compared to the reference group (Anti-oxidant diet & Non-Obese group). The Anti-oxidant diet & Obese group (adjusted OR 2.03, 95% CI: 1.59-2.59) and the Pro-oxidant diet & Non-Obese group (adjusted OR 1.33, 95% CI: 1.08-1.64) also showed elevated risks, although to a lesser extent. These findings suggest that both dietary factors and obesity independently contribute to CMM risk, but their combined effect is more pronounced. The interaction between a pro-oxidant diet and obesity was synergistic, with the RERI indicating a positive interaction (0.75, 95% CI: 0.21, 1.29), the AP showing 24% of the combined effect due to their interaction, and the SI indicating a synergistic effect greater than additive (SI 1.55, 95% CI: 1.11-2.16). Subgroup analyses showed stronger interactions in females, younger individuals, non-Hispanic Whites, and those with hypertension.

CONCLUSIONS

Obesity and a pro-oxidative diet are correlated with the occurrence of CMM; there exists an interaction between obesity and a pro-oxidative diet concerning the initiation and advancement of CMM. Subgroup studies revealed more pronounced interactions among females, younger adults, non-Hispanic Whites, and individuals with hypertension.

Role of sarcopenia in Temporal progression trajectory of cardiometabolic diseases: a prospective study in UK biobank

BACKGROUND

Although sarcopenia has been linked to a range of cardiometabolic diseases (CMDs, including coronary heart disease [CHD], stroke, and diabetes here), its role in the temporal progression from healthy to single CMD, subsequently to cardiometabolic multimorbidity (CMM, coexistence of ≥ 2 CMDs in an individual), and further to death remains unclear. In this study, we aimed to examine the associations of sarcopenia with the risk of CMDs, CMM, and mortality along the CMD progression trajectory.

METHODS

We used data from UK Biobank of 413,326 participants free of CMDs at baseline. Multi-state models were used to analyze the transition-specific associations of sarcopenia status measured by handgrip strength, muscle mass, and gait speed (according to the 2019 European Working Group of Sarcopenia in Older People 2) with the progression from no CMD to single CMD, CMM, and ultimately to death. The role of specific sarcopenia components was also assessed.

RESULTS

During a median follow-up of 13.1 years, 51,705 participants experienced ≥ 1 CMD, 6,003 had CMM, and 24,495 died. Compared with people free of sarcopenia, participants with confirmed/severe sarcopenia had higher risk experiencing transitions from no CMD to single CMD or death (hazard ratio [HR] 1.42 and 2.08) and also higher risk from single CMD to CMM progression or death (HR 1.69 and 2.05). Significant associations were observed for participants with probable sarcopenia with smaller effect sizes. All three sarcopenia components increased the risk of most transitions, and stronger associations were observed for low gait speed. In stratified analyses, the associations between sarcopenia and mortality-related transitions were modified by specific lifestyles.

CONCLUSIONS

Sarcopenia is an independent risk factor of CMD, CMM progression, and all-cause mortality among middle-aged and older people.

2025 SWHR Women's Health Research Agenda: Prioritizing Uterine Fibroids, Lupus, and Metabolism

Women face unique and multifaceted challenges throughout their lifespans, shaped by biological, societal, and health care-related factors. These challenges have led to gender disparities in disease burden, access to care, and representation in medical research, underscoring the need to increase targeted investments in women's health. Historically, research on diseases that disproportionately affect women has been underfunded, hindering progress in closing gender health gaps. In March 2024, the President of the United States signed an Executive Order on Women's Health Research and Innovation, signaling a new commitment by the federal government to prioritize women's health research and address these disparities. The Society for Women's Health Research (SWHR) has consistently led the charge to identify research gaps and advocate for evidence-based initiatives to improve the health and well-being of women. In celebration of its 35th anniversary, SWHR introduces a 2025 Women's Health Research Agenda, which outlines key priorities in the areas of uterine health, autoimmune disease, and cardiometabolic health. This agenda serves as a strategic roadmap for stakeholders to engage with critical areas of women's health, fostering collaboration and accelerating research to address the unmet needs of women across the lifespan.

Structural and load-dependent arterial stiffness across the adult life span

BACKGROUND

The arterial stiffening is attributed to the intrinsic structural stiffening and/or load-dependent stiffening by increased blood pressure (BP). The respective lifetime alterations and major determinants of the two components with normal aging are not clear.

METHODS

A total of 3053 healthy adults (1922 women) aged 18-79 years were enrolled. The carotid intima-media thickness, diameter, and local BPs were automatically determined by the radio frequency ultrasound system. The Peterson and Young elastic moduli were then calculated to represent total arterial stiffness. Structural stiffness was recalculated at a reference BP of 120/80 mmHg with established models. Load-dependent stiffness was the difference between total and structural stiffness.

RESULTS

Both structural and load-dependent stiffness increased with aging, with much larger changes in the structural components. The age-related increasing rates were higher in women for the structural stiffness than men ( P  < 0.05), but similar for the load-dependent stiffness. The clinical characteristics and arterial stiffness were widely correlated, but most correlations were quite weak ( r  < 0.3) other than BPs. Multiple regression analyses adjusted for sex, age and other clinical correlates showed that structural stiffness increased with pulse pressure (PP) and load-dependent stiffness increased with mean arterial pressure (MAP), respectively.

CONCLUSION

The age-related arterial stiffening is mainly caused by the intrinsic structural stiffening, which demonstrated significant age-sex interaction. BPs were the major clinical determinants of arterial stiffness, with PP and MAP associated with different arterial stiffness components. The differentiation of the structural and load-dependent arterial stiffness should be highlighted for the optimal vascular health management.

The Influence of Metabolic and Bariatric Surgery on Cardiovascular Health in Women: A Comprehensive Study

BACKGROUND

Cardiovascular disease (CVD) is the main cause of death in patients with obesity. Bariatric surgery has been shown to promote substantial reduction in carotid intima-media thickness (C-IMT).

AIM

To comprehensively determine the influence of metabolic and bariatric surgery (MBS) on cardiovascular health in women.

METHODS

A total of 24 female patients with a body mass index (BMI) > 35 kg/m2 underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or one anastomosis gastric bypass (OAGB), a prospective cohort study in women. C-IMT were evaluated at baseline and 24 months post-MBS.

RESULTS

The results showed a significant reduction in BMI, weight, and C-IMT on the right side 24 months post-MBS (p < 0.001 for BMI and weight and p = 0.004 for C-IMT). There were also significant differences in fasting blood sugar (FBS), triglycerides (TG), total cholesterol, and low-density lipoprotein (LDL) levels. However, high-density lipoprotein (HDL) levels did not show a significant change.

CONCLUSION

The study underscores the potential of MBS in mitigating cardiovascular risk among women with obesity. However, further research is needed to fully understand the impact of MBS on various parameters. The findings highlight the importance of personalized and gender-specific approaches in the management of obesity and related disease.

Sex-Specific Associations of Cardiovascular Risk Factors With Subclinical Cardiac Remodelling: A Magnetic Resonance Imaging Study

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death in women, yet sex-specific risk factor influences remain understudied. Cardiac magnetic resonance (CMR) imaging detects early remodelling via left ventricular mass-to-volume ratio (LVMV), a validated concentricity marker. This study examines sex differences in the association of cardiovascular (CV) risk factors, diet, and cardiac remodelling.

METHODS

We analyzed 622 age-matched adults (51% female, mean age 50.8 ± 9.5) from the Courtois Cardiovascular Signature Program. LVMV was defined as left ventricular (LV) systolic mass divided by end-diastolic volume. Alcohol and sugar intake was self-rated on a Likert scale. Mann-Whitney U and regression analyses assessed sex-specific associations between CV risk factors and LVMV.

RESULTS

Hypertension was present in 20.6% of men and 17.4% of women: diabetes in 9.8% and 6.0%. Men had higher triglycerides, alcohol/sugar intake, and LVMV (0.92 ± 0.20 vs 0.77 ± 0.18 g/mL). Hypertension correlated with higher LVMV in both sexes (men: ß = 0.099, P < 0.001; women: ß = 0.078, P < 0.05), whereas triglycerides (ß = 0.032, P < 0.05) and alcohol intake (H = 19.41, P < 0.0001) were male-specific predictors. In female patients, diabetes and sugar intake were significantly associated with LVMV (ß = 0.102, ß = 0.062, P < 0.05).

CONCLUSIONS

CV risk factors affect cardiac remodelling differently by sex. In men, LVMV was linked to triglycerides and alcohol intake, whereas in women, diabetes and sugar intake showed stronger associations. These results underscore the need for tailored CV prevention strategies that account for sex differences in metabolic and lifestyle risk factors.

CLINICAL TRIAL REGISTRATION

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The association of nutritional and inflammatory status with cardiovascular and all-cause mortality risk among US patients with metabolic syndrome

To investigate the relationship between nutritional and inflammatory status and all-cause and cardiovascular mortality in the U.S. population with cardiometabolic syndrome (CMS) and to identify the optimal nutrition-inflammation index for assessing long-term prognosis. Health data from the 1999-2010 National Health and Nutrition Examination Survey (NHANES) were used. Kaplan-Meier analysis explored associations between nutrition-inflammation indices and mortality in the CMS population. Significant indices were selected for ROC curve analysis, and the most effective index was analyzed using COX regression models. Restricted cubic splines (RCS) analyzed nonlinear associations, and a recursive algorithm determined inflection points. Subgroup and sensitivity analyses assessed the stability of the model. The study included data from 5,969 participants (2,900 males, 3,069 females), with 1,753 all-cause deaths and 607 cardiovascular deaths. Kaplan-Meier analysis indicated that good nutrition and low inflammation were linked to better long-term outcomes. The Advanced Lung Cancer Inflammation Index (ALI) was the most effective assessing index. COX regression showed a negative association between ALI and both mortality types. RCS analysis revealed a U-shaped relationship for all-cause mortality and an L-shaped curve for cardiovascular mortality, with an inflection point at 106.24. Subgroup analysis and sensitivity analysis confirmed the robustness of ALI in assessing the mortality risk in the CMS population. ALI is an ideal indicator for evaluating the relationship between nutritional and inflammatory status and both all-cause and cardiovascular mortality in the CMS population. Maintaining an appropriate ALI level can help reduce the risk of all-cause and cardiovascular mortality in CMS patients.

Sexual Dimorphism in Cardiometabolic Diseases: From Development to Senescence and Therapeutic Approaches

The global incidence and prevalence of cardiometabolic disorders have risen significantly in recent years. Although lifestyle choices in adulthood play a crucial role in the development of these conditions, it is well established that events occurring early in life can have an important effect. Recent research on cardiometabolic diseases has highlighted the influence of sexual dimorphism on risk factors, underlying mechanisms, and response to therapies. In this narrative review, we summarize the current understanding of sexual dimorphism in cardiovascular and metabolic diseases in the general population and within the framework of the Developmental Origins of Health and Disease (DOHaD) concept. We explore key risk factors and mechanisms, including the influence of genetic and epigenetic factors, placental and embryonic development, maternal nutrition, sex hormones, energy metabolism, microbiota, oxidative stress, cell death, inflammation, endothelial dysfunction, circadian rhythm, and lifestyle factors. Finally, we discuss some of the main therapeutic approaches, responses to which may be influenced by sexual dimorphism, such as antihypertensive and cardiovascular treatments, oxidative stress management, nutrition, cell therapies, and hormone replacement therapy.

Endogenous Estrogen Exposure and Hypertension Risk; A Population-based Cohort Study With About 2 Decades of Follow-up

CONTENT

The impact of endogenous estrogen exposure (EEE) on hypertension (HTN) incidence has not been investigated yet.

OBJECTIVE

This study aimed to evaluate HTN incidence in women with different endogenous estrogen durations.

METHODS

Information was gathered from the Tehran Lipid and Glucose Study to conduct current research. At the initiation of the study, 4463 postmenarche normotensive women, including 3599 premenopausal and 864 menopausal women, were included. EEE was calculated for each woman, and they were followed up for the HTN event. According to the EEE, the hazard ratios and 95% confidence intervals (CI) for the HTN event were presented using Cox proportional hazards regression models (unadjusted and adjusted).

RESULTS

The median (interquartile range) of follow-up (between menarche and the date of HTN incidence or last follow-up) was 33.2 (25.1, 42.3) years. The event of menopause occurred in 31.8% of participants. The unadjusted model's findings illustrated that the EEE z-score was inversely associated with HTN incidence in postmenarcheal women [unadjusted hazard ratio (HR) .47, 95% CI .44-.50], meaning that the risk of HTN decreased by 53% for every 1-SD rise in the EEE z-score. After adjusting for potential confounders, the results showed no statistically significant changes (adjusted HR .46, 95% CI .43-.49). In participants with prehypertension at baseline, the hazard of HTN decreased by 56% per 1-SD rise in the EEE z-score.

CONCLUSION

This longitudinal study demonstrated the protective effect of a longer EEE duration on HTN risk, even among those with prehypertension status.

Menopause-related changes in vascular signaling by sex hormones

Cardiovascular disease (CVD), such as hypertension and coronary artery disease, involves pathological changes in vascular signaling, function, and structure. Vascular signaling is regulated by multiple intrinsic and extrinsic factors that influence endothelial cells, vascular smooth muscle, and extracellular matrix. Vascular function is also influenced by environmental factors including diet, exercise, and stress, as well as genetic background, sex differences, and age. CVD is more common in adult men and postmenopausal women than in premenopausal women. Specifically, women during menopausal transition, with declining ovarian function and production of estrogen (E2) and progesterone, show marked increase in the incidence of CVD and associated vascular dysfunction. Mechanistic research suggests that E2 and E2 receptor signaling have beneficial effects on vascular function including vasodilation, decreased blood pressure, and cardiovascular protection. Also, the tangible benefits of E2 supplementation in improving menopausal symptoms have prompted clinical trials of menopausal hormone therapy (MHT) in CVD, but the results have been inconsistent. The inadequate benefits of MHT in CVD could be attributed to the E2 type, dose, formulation, route, timing, and duration as well as menopausal changes in E2/E2 receptor vascular signaling. Other factors that could affect the responsiveness to MHT are the integrated hormonal milieu including gonadotropins, progesterone, and testosterone, vascular health status, preexisting cardiovascular conditions, and menopause-related dysfunction in the renal, gastrointestinal, endocrine, immune, and nervous systems. Further analysis of these factors should enhance our understanding of menopause-related changes in vascular signaling by sex hormones and provide better guidance for management of CVD in postmenopausal women. SIGNIFICANCE STATEMENT: Cardiovascular disease is more common in adult men and postmenopausal women than premenopausal women. Earlier observations of vascular benefits of menopausal hormone therapy did not materialize in randomized clinical trials. Further examination of the cardiovascular effects of sex hormones in different formulations and regimens, and the menopausal changes in vascular signaling would help to adjust the menopausal hormone therapy protocols in order to enhance their effectiveness in reducing the risk and the management of cardiovascular disease in postmenopausal women.

Sex Differences in Longitudinal Tau-PET in Preclinical Alzheimer Disease: A Meta-Analysis

Importance

Alzheimer disease (AD) predominates in females at almost twice the rate relative to males. Mounting evidence in adults without AD indicates that females exhibit higher tau deposition than age-matched males, particularly in the setting of elevated β-amyloid (Aβ), but the evidence for sex differences in tau accumulation rates is inconclusive.

Objective

To examine whether female sex is associated with faster tau accumulation in the setting of high Aβ (as measured with positron emission tomography [PET]) and the moderating influence of sex on the association between APOEε4 carrier status and tau accumulation.

Data Sources

This meta-analysis used data from 6 longitudinal aging and AD studies, including the Alzheimer's Disease Neuroimaging Initiative, Berkeley Aging Cohort Study, BioFINDER 1, Harvard Aging Brain Study, Mayo Clinic Study of Aging, and Wisconsin Registry for Alzheimer Prevention. Longitudinal data were collected between November 2004 and May 2022.

Study Selection

Included studies required available longitudinal [18F]flortaucipir or [18F]-MK-6240 tau-PET scans, as well as baseline [11C] Pittsburgh Compound B, [18F]flutemetamol or [18F]florbetapir Aβ-PET scans. Recruitment criteria varied across studies. Analyses began on August 7, 2023, and were completed on February 5, 2024.

Data Extraction and Synthesis

In each study, primary analyses extracted estimates for the sex (female or male) and the sex by baseline Aβ-PET status (high or low) association with longitudinal tau-PET using a series of mixed-effects models. Secondary mixed-effects models extracted the interaction estimate for the association of sex by APOEε4 carrier status with longitudinal tau-PET. Study-specific estimates for each mixed-effects model were then pooled in a meta-analysis, and the global fixed effect (β) and total heterogeneity (I2) across studies were estimated. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Main Outcomes and Measures

Seven tau-PET outcomes that showed cross-sectional sex differences were examined across temporal, parietal, and occipital lobes.

Results

Among 6 studies assessed, there were 1376 participants (761 [55%] female; mean [range] age at first tau scan, 71.9 [46-93] years; 401 participants [29%] with high baseline Aβ; 412 APOEε4 carriers [30%]). Among individuals with high baseline Aβ, female sex was associated with faster tau accumulation localized to inferior temporal (β = -0.14; 95% CI, -0.22 to -0.06; P = .009) temporal fusiform (β = -0.13; 95% CI, -0.23 to -0.04; P = .02), and lateral occipital regions (β = -0.15; 95% CI, -0.24 to -0.06; P = .009) compared with male sex. Among APOEε4 carriers, female sex was associated with faster inferior-temporal tau accumulation (β = -0.10; 95% CI, -0.16 to -0.03; P = .01).

Conclusions and Relevance

These findings suggest that sex differences in the pathological progression of AD call for sex-specific timing considerations when administrating anti-Aβ and anti-tau treatments.

Cardiometabolic deaths in black and white men: Tracing the risks from early- to mid-adulthood

Objective

This study aimed to estimate and compare cardiometabolic disease (CMD) mortality in U.S. Black and White men during the transition from early adulthood to middle age.

Methods

Using 2022 National Vital Statistics System data and standard period life table methods, we estimated the risk of CMD death in hypothetical cohorts of Black and White men from age 25 to 45 years. We estimated cumulative risk, excess mortality, years of lost life (YLL), and proportion of deaths due to CMD, stratifying by metabolic and cardiovascular disease.

Results

Of the 325,134 Black men aged 25 years in the initial cohort, the cumulative risk of cardiometabolic death before age 45 was one in 63 individuals or 1.58 %. For White men, the risks were markedly lower. Of the 1,185,384 White men aged 25 years in the initial cohort, the cumulative risk of cardiometabolic death before age 45 was one in 158 individuals or 0.63 %. The study also found that of the 5141 expected CMD deaths in the Black cohort, 3090 or 60.10 % were excess deaths relative to the White cohort. Additionally, the proportion of all deaths due to CMD among Black men was 19.15 % rising from 6.02 % at age 25 to 38.00 % at age 45, compared with 11.10 % among White men, increasing from 4.57 % at age 25 to 19.79 % at age 45. The YLL for Black men averaged 6.72 months per person while White men averaged 2.94 months.

Conclusions

This investigation shows profound racial disparities in CMD mortality from early to mid-adulthood.

The burden of cardiovascular disease in children in Asian countries (1990-2021): Systematic analysis and projection of the burden of disease

Background

Cardiovascular disease (CVD) is the leading global cause of death and health loss. The epidemiology and factors influencing CVD in children are unique, making it essential to first evaluate current and future trends to guide interventions and reduce the disease burden.

Objective

To analyze the incidence, mortality, and disability-adjusted life years (DALY) of CVD in children aged 0-14 from 1990 to 2021, and explore global disease burden, risk factors, and trends over the next 30 years. The study focuses on China, Japan, South Korea, India, and Singapore to aid in developing targeted prevention and treatment strategies.

Methods

Using data from the Global Burden of Disease Study (GBD) 1990-2021, we assessed age- and sex-specific morbidity, mortality, and DALY of CVD in Asian children aged 0-14 and computed the EAPC. We analyzed risk factors, specific causes, and projected prevalence trends through 2050 using the Bayesian Age-Period-Cohort (BAPC) model.

Results

From 1990 to 2021, CVD incidence among Asian children aged 0-14 decreased by 8.03 % (95 % UI:13.63 to -4.02). Mortality saw a significant drop of 67.98 % (95 % UI:73.73 to -62.23), with the greatest decline in children aged 2-4, and the highest death rate in those under 1 year. Disability and mortality patterns were similar across gender, age, etiology, and overall trends. In 2021, South Asia had the highest rates of morbidity, mortality, and disability. Rates varied significantly, with Mongolia exhibiting the highest rate and Cyprus the lowest, showing a sixfold difference. Rheumatic heart disease (RHD) and intracerebral hemorrhage were the most critical diseases needed attention. Abnormal temperatures were identified as a risk factor associated with CVD outcomes in children. The burden of CVD is projected to increase in various regions and countries across Asia.

Conclusion

The burden of CVD continues to challenge children aged 0-14 in Asia. Enhancing our understanding of pediatric CVD epidemiology, addressing risk factors, and reinforcing prevention and control measures are essential for reducing this burden.

Harnessing a Self-Regenerated Hybridization Circuit for Differentiating Heart Failure Patients of Varied Severity

Heart failure (HF) is a globally threatening cardiovascular disease associated with poor quality of life and high mortality, therefore, timely diagnosis and risk prediction for HF disease are urgently needed. Herein, a compact yet robust self-regenerated hybridization circuit (SHC) aptasensor is developed for the amplified detection of N-terminal pro-brain natriuretic peptide (NT-proBNP), a "gold standard biomarker" for HF. The aptamer transduction module can specifically recognize NT-proBNP, thus initiating the cascade hybridization reaction with the successively self-regenerated triggers that reversely initiate the cross-hybridization reaction. Benefiting from the aptamer-specific recognition and the self-replicated signal amplification, the robust SHC aptasensor demonstrated a more impressive diagnostic performance for HF in elderly patients than the clinical fluorescence immunochromatography assay (FICA) in terms of positive predictive value (21 vs 17), specificity (39 vs 32), and diagnostic accuracy (37 vs 36). Furthermore, this approach allows for differentiation among HF patients with varying disease severities, achieving a sufficiently high accuracy of 78.3%, thus facilitating more timely and accurate therapeutic intervention. The versatile and reliable SHC system offers a new approach to analyzing low-abundance biomarkers from clinical rare specimens, which is highly important for early disease diagnosis and prognosis assessment.

Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people

OBJECTIVE

To examine cardiovascular risk factors in 40-year-old participants in the health screening program targeted health dialogues (THDs).

DESIGN

Cross-sectional study.

SETTING

99 Swedish healthcare centers.

INTERVENTION

Metabolic risk factors and health behaviors were assessed. THDs were provided.

SUBJECTS

1831 (62.3%) THD participants that consented to take part in the research project.

MAIN OUTCOME MEASURES

(1) Prevalence of metabolic risk factors (blood pressure, LDL cholesterol, fasting plasma glucose, BMI, waist-hip ratio) and unhealthy behaviors (tobacco, alcohol, diet, physical activity) by sex, education, and place of birth. (2) Associations between different health behaviors and between the number of unhealthy behaviors and prevalence of metabolic risk factors. (3) THD participation by sociodemographics compared to age-matched controls.

RESULTS

Men had a higher prevalence of all metabolic risk factors, excessive alcohol use and tobacco use than women. Lower educated individuals had a higher prevalence of metabolic risk factors (except for LDL cholesterol) and tobacco use than highly educated. Participants born outside Sweden had a higher prevalence of obesity, high waist-hip ratio, and tobacco use. Participants with 3-4 unhealthy behaviors had significantly higher prevalence of each of the metabolic risk factors except BMI. Women, highly educated and Swedish-born participants were slightly over-represented in the THDs.

CONCLUSION

Considering the associations between unhealthy behaviors and metabolic risk factors, the THD method, covering lifestyle as well as objective health measures, may be an appropriate method for early identification of individuals at risk for future non-communicable diseases in the whole population with a specific focus on certain groups.

CLINICALTRIALS.GOV

NCT04912739.

Exploring Visceral Fat as a Screening Marker for Cardiometabolic Risk in Children and Adolescents

Objective: To establish and validate age- and sex-specific visceral fat area (VFA) cutoff values for the effective identification of cardiometabolic risk (CMR) in children and adolescents. Methods: A cross-sectional study involving 8133 participants was conducted to derive age- and sex-specific VFA cutoffs, which were validated in a longitudinal cohort comprising 10,805 individuals. The predictive performance of the derived VFA cutoffs for CMR was evaluated using the area under the receiver operating characteristic curve (AUC). Additionally, logistic regression models were utilized to calculate the relative risk (RR) of CMR associated with elevated VFA levels. Results: The 75th percentile of the VFA was identified as the optimal cutoff for screening for hypertension, hyperglycemia, dyslipidemia, and CMR clustering in boys. In girls, the 75th percentile was optimal for screening hypertension, dyslipidemia, and CMR clustering, while the 80th percentile proved best for hyperglycemia. No significant difference in predicative performance was observed between the optimal and simplified VFA cutoffs. Longitudinal validation demonstrated that individuals exceeding the VFA cutoff had a significantly higher risk for CMR, with RRs ranging from 1.33 to 3.89 (all p < 0.001) for boys and from 1.63 to 3.16 (all p < 0.001) for girls. Notably, normal-weight boys with VFA above the cutoff had a significantly higher CMR risk compared to their peers in other weight status categories. Conclusions: Both the optimal and simplified VFA cutoffs are robust tools for screening CMR in Chinese children and adolescents, with significant implications for early intervention strategies.

Hepatic lipid metabolism is altered in Ubiad1+/- mice of both sexes

UbiA prenyltransferase domain containing 1 (Ubiad1) has the potential to affect cholesterol and phospholipid levels in different cell types. We previously identified Ubiad1 as a candidate gene for regulating subcutaneous fat pad weight in a mouse genome-wide association study. Here we evaluated the relationship between Ubiad1 and obesity-related traits in cohorts of humans and mice, and in Ubiad1+/- mice fed a high-fat diet. In both humans and mice, adipose tissue Ubiad1 mRNA expression correlated negatively with adiposity and positively with mitochondria-related genes. To determine the role of Ubiad1 in high-fat diet-induced obesity, we disrupted the Ubiad1 gene in mice. Deletion of Ubiad1 was embryonically lethal in C57BL/6 N mice, preventing analysis of adult Ubiad1-/- mice. Thus, male and female Ubiad1+/+ and Ubiad1+/- mice were fed high-fat diet for 10 weeks, with no difference in weight gain and adipose tissue organ weights observed between the genotypes. Analysis of liver mRNA expression revealed that Ubiad1 heterozygosis (Ubiad1+/-) altered several pathways involved in lipid metabolism. Detailed lipid quantification with HPLC-qTOF/MS showed increased levels of hepatic ceramides in female Ubiad1+/- mice, whereas phosphatidylglycerols, phosohatidylinositol and lysophosphatidylethanolamines were reduced in male Ubiad1+/- mice. Our findings reveal sex-specific effects of Ubiad1 expression on hepatic lipid metabolism.

Elevated 18:1 lysophosphatidylcholine contributes to neuropathic pain in peripheral nerve injury

BACKGROUND

Neuropathic pain is a maladaptive and chronic condition with limited effective treatments. Although recent studies have suggested that certain lipid metabolites, like lysophosphatidylcholine (LPC), may contribute to chronic pain, their specific roles and mechanisms remain unclear.

OBJECTIVE

This study investigated the role and mechanism of LPC(18:1), a lipid subtype, in neuropathic pain caused by nerve injury.

METHODS

Using a mouse model of spinal nerve ligation, LPC(18:1) levels were measured in serum, dorsal root ganglion (DRG), spinal cord (SC) and cerebrospinal fluid (CSF). Nociception was assessed using von Frey and Hargreaves' methods, while molecular analyses explored inflammatory pathways and oxidative stress.

RESULTS

LPC(18:1) levels significantly increased in the serum, DRG and CSF after nerve injury. Administration of LPC(18:1) induced heightened pain responses and activated inflammatory pathways, including protein kinase C (PKC) and extracellular regulated protein kinase (ERK) in the DRG, as well as glial cells in the SC. The findings suggested that oxidative stress played a role in LPC(18:1) production, and its effects were mediated by G protein-coupled receptor 132 (GPR132).

CONCLUSION

LPC(18:1) may serve as a potential biomarker and therapeutic target for managing neuropathic pain.

Lifestyle interventions in later reproductive age women to offset cardiometabolic and bone disease: a scoping review

BACKGROUND

Non-communicable chronic disease is a major contributor to morbidity and mortality with potentially modifiable lifestyle factors. In women, the menopausal transition modifies women's risk of chronic disease, and pregnancy-related complications have been highlighted as female-specific risk factors. Later reproductive years, before onset of menopause, may represent a window of opportunity for promotion of lifestyle modifications. The aim of this scoping review is to investigate which interventions promoting lifestyle modifications in women of later reproductive years may influence cardiometabolic and bone disease.

METHODS

A search of three electronic databases (PubMed, Embase, CINAHL) in the English language was performed in January 2024. Eligible studies included women aged 40-55 participating in interventions focusing on lifestyle modification. Studies reporting outcomes related to cardiometabolic disease, bone disease or body composition were eligible for inclusion.

RESULTS

Improvements in body composition occurred following interventions focusing on aerobic physical activity. Interventions focusing on health promotion and education, incorporating both dietary and physical activity modifications, prevented weight gain and improved cardiometabolic outcomes. Interventions incorporating elements of behavioural theories enhanced patient-motivated lifestyle modifications, with effects on body composition and cardiometabolic outcomes.

CONCLUSIONS

Lifestyle modifications in later reproductive years have the potential to influence cardiometabolic and bone disease. Our findings reinforce the benefits of regular aerobic physical activity, as well as health education, for improving body composition and lipid profile. This information could contribute to the development of clinical guidelines for the prevention of chronic disease.

Cardiac MRI Strain as an Early Indicator of Myocardial Dysfunction in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is often characterized by augmented cardiac contractility, which frequently remains undetectable in its early stages. Emerging evidence suggests that hypercontractility is linked to mitochondrial defects that develop early in HCM progression. However, imaging markers for identifying these early alterations in myocardial function are lacking. We used cardiac magnetic resonance feature tracking (CMR-FT) to assess myocardial strain in a Mybpc3-knockin (KI) mouse model that mimicked human HCM. While homozygous (HOM) mice exhibited cardiac hypertrophy, heterozygous (HET) mice represented an early, asymptomatic stage of HCM. To explore mitochondrial contributions to hypercontractility, we evaluated mitochondrial integrity via scanning electron microscopy (SEM) and correlated these findings with strain abnormalities. Young HET female, but not male mice exhibited significant torsion abnormalities (p = 0.02), reduced left ventricular global longitudinal strain (LVGLS, p = 0.009), and impaired right ventricular global longitudinal strain (RVGLS, p = 0.035) compared to the controls. Strain abnormalities correlated strongly with mitochondrial morphological alterations, including changes in volume and area distribution (R > 0.7). Abnormal myocardial strain patterns, including torsion and GLS, serve as early markers of HCM and are closely associated with underlying mitochondrial dysfunction. The HET Mybpc3-KI HCM model provides important insights into the initial stages of HCM progression, highlighting strain abnormalities and sex-specific differences to enhance early diagnosis and therapeutic strategies.

Global, regional, and national burden of atrial fibrillation and atrial flutter from 1990 to 2021: sex differences and global burden projections to 2046-a systematic analysis of the Global Burden of Disease Study 2021

AIMS

Atrial fibrillation and atrial flutter (AF/AFL) are critical global health concerns, yet studies on burden trends and sex differences remain limited. This study aims to investigate the global burden trends of AF/AFL, with an in-depth analysis of differences between sexes and future trends, in order to address gaps in the current research field.

METHODS AND RESULTS

This study utilized data from the Global Burden of Disease 2021 study, applying methods such as age-period-cohort analysis and joinpoint regression models to evaluate trends and sex differences in the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of AF/AFL among individuals aged 30 and above from 1990 to 2021, and employed Bayesian age-period-cohort (BAPC) analysis to predict future trends from 2022 to 2046. In 2021, AF/AFL affected around 52.6 million people globally, with significant increases in cases, deaths, and DALYs since 1990. While the age-standardized prevalence rate (ASPR) remained stable, the age-standardized incidence rate (ASIR) slightly declined, and the age-standardized mortality rate (ASMR) increased. Moreover, there were significant differences in the disease burden between male and female patients. Males had higher prevalence and DALYs, with older age contributing to higher rates. Key risk factors included high systolic blood pressure, body mass index (BMI), and alcohol use, with female patients exhibiting a higher age-standardized rates associated with elevated BMI compared with their male counterparts. Bayesian age-period-cohort predicted stable ASPR and ASIR in males but rising rates in females, with ASMR expected to decline for both sexes.

CONCLUSION

The global burden of AF/AFL is rising, particularly among women, and in low-socio-demographic index regions. This underscores the urgent need for targeted prevention strategies and optimized management of modifiable risk factors, with a specific focus on these vulnerable groups.

Normal-weight obesity subtypes and 10-year risks of major vascular diseases in 0.3 million adults

BACKGROUND & AIMS

Obesity directly contributes to the progression of cardiovascular disease, but little is known about the association and risk attribution of normal-weight obesity subtypes with the incidence of major vascular events (MVEs) and their subtypes.

METHODS

This is a prospective cohort study based on the China Kadoorie Biobank (CKB). A total of 308,071 individuals with no prior vascular diseases or cancer were included at baseline. The incidence of MVEs and their subtypes were recorded during follow-up. Adjusted hazard ratios (HRs) for each disease were yielded by Cox regression.

RESULTS

During a median follow-up of 10.3 years, 62,040 MVEs occurred, with the adjusted HRs (95 % confidence intervals) were 1.11 (1.09-1.13) for normal-weight general obesity (NWGO), 1.27 (1.23-1.31) for normal-weight central obesity (NWCO), and 1.30 (1.27-1.33) for normal-weight central and general obesity (NWCGO). For subtypes of MVEs, increased waist circumference (WC) was associated with excess risk of ischaemic heart disease (IHD) independent of body fat percent (BF%) levels (HR range: 1.30-1.69 in men; 1.36-1.55 in women), while the risk plateaued with rising BF% within each WC quartile. However, even in men with lower WC (≤78 cm [median]), the risks of cerebrovascular disease (CeVD), particularly ischaemic stroke (IS), were increased with higher BF% (all P < 0.01). Conversely, in women, independent dose-response associations were primarily observed between increasing WC and CeVD, with the highest risk observed for IS (HR 1.38, 1.31-1.47).

CONCLUSIONS

This study provided novel, sex-specific evidence that normal-weight obesity subtypes were associated with distinct risks of subtypes of MVEs, with elevated risks predominantly attributable to WC in women and both WC and BF% in men.

Sex Modifies the Severity and Outcome of Spontaneous Intracerebral Hemorrhage

OBJECTIVE

The limited existing evidence on sex differences in the clinical characteristics of patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH) comes from small, single-center studies. Here, we performed an individual patient data meta-analysis of 3 randomized clinical trials and 1 multi-ethnic observational study of ICH to investigate the impact of sex on ICH severity and outcome.

METHODS

Inclusion criteria in our study were a neuroimaging-confirmed ICH. We evaluated whether sex was associated with ICH severity (hematoma volume and expansion) and poor functional outcomes (modified Rankin Scale >3) 3 or 6 months after the ICH.

RESULTS

A total of 4,812 ICH patients were evaluated (mean age 62, 40% female). Males with ICH were younger, more likely to be smokers and have diabetes, and less likely to be on anticoagulants (all p < 0.05). In multivariable analyses, male sex was associated with non-lobar location (odds ratio [OR]: 1.63; 95% confidence interval [CI]: [1.39-1.92]; p < 0.001), larger hemorrhages (beta: 0.16 [0.08-0.23]; p < 0.001) and a higher risk of hematoma expansion (OR: 1.43 [1.20-1.71]; p < 0.001). Despite the larger hemorrhage volume and higher risk of expansion, male sex was associated with a 24% lower risk of poor outcomes (OR: 0.76 [0.64-0.90]; p = 0.002).

INTERPRETATION

Compared to females, males with ICH have larger bleeds and higher risk of hematoma expansion. Despite the larger bleeds and higher risk of hematoma expansion, males with ICH have lower risk of poor outcomes. Our results suggest that the biology and clinical trajectory are different in females and males with ICH, supporting sex-specific research in this condition. ANN NEUROL 2025;97:232-241.

Association between triglyceride glucose index and adverse cardiovascular prognosis in patients with atrial fibrillation without diabetes: a retrospective cohort study

BACKGROUND

Atrial fibrillation (AF) is the most prevalent arrhythmia encountered in clinical practice. Triglyceride glucose index (Tyg), a convenient evaluation variable for insulin resistance, has shown associations with adverse cardiovascular outcomes. However, studies on the Tyg index's predictive value for adverse prognosis in patients with AF without diabetes are lacking.

METHODS

This retrospective study utilized electronic medical records to collect data on patients with AF hospitalized at West China Hospital from January to June 2020. Participants were categorized into three groups based on their Tyg index levels. The primary outcome, major adverse cardiovascular events, included cardiac death, stroke, and myocardial infarction. Kaplan-Meier curve, Cox proportional hazards regression model, and restricted cubic spline were employed to explore the relationship between the Tyg index and outcomes. The predictive performance of the CHA2DS2-VASc model was evaluated after incorporating the Tyg index.

RESULTS

The study comprised 864 participants (mean age 67.69 years, 55.32% male, 57.52% paroxysmal AF). Patients with high Tyg index had a significantly higher risk of developing major adverse cardiovascular events (MACE) (P < 0.001, hazard ratio: 2.05, 95% confidence interval:1.65-2.56). The MACE risk in the middle Tyg group was similar to that in the low Tyg group (P = 0.1) during the 48-month follow-up period. However, focusing on the last 24 months revealed a higher MACE risk (P = 0.015) in the middle Tyg group. The restricted cubic spline analysis revealed an S-shaped correlation between Tyg and MACE. The CHA2DS2-VASc model combined with the Tyg index showed improved predictive performance and net benefit.

CONCLUSIONS

A high Tyg index is associated with poorer prognosis in patients with AF without diabetes. Integrating the Tyg index into the CHA2DS2-VASc model may enhance its predictive performance, offering clinical utility.

Association of novel metabolic status with asymptomatic intracranial arterial stenosis: A cross-sectional study

OBJECTIVES

To investigate the association of metabolic status newly defined or obesity with asymptomatic intracranial arterial stenosis (aICAS) among populations in rural China.

METHODS

The cross-sectional study is based on the Rose asymptomatic IntraCranial Artery Stenosis (RICAS) cohort, which enrolled 2005 participants aged 40 years or older without a history of clinical stroke or transient ischemic attack. Metabolically healthy status (MH) was defined by a newly proposed criterion: (1) systolic blood pressure (SBP) < 130 mmHg and without antihypertensive medication; (2) a waist-to-hip ratio (WHR) below 1.03 for men and below 0.95 for women; (3) no diabetes. All participants were categorized based on their metabolic status and obesity. Multivariate logistic regression models were used to investigate the association between metabolic status or obesity and aICAS.

RESULTS

Among 2005 participants, 1597 (79.65%) were defined as metabolically unhealthy status (MU) according to the new criterion. MU was significantly associated with aICAS (OR 2.02, 95% CI 1.11-3.68, P = 0.021), especially moderate-to-severe aICAS (OR 2.43, 95% CI 1.04-5.72, P = 0.042). The prevalence of aICAS increased with the numbers of metabolic disorders (P for linear trend <0.001). Both metabolically unhealthy normal-weight (MUN) (OR 2.11, 95% CI 1.10-4.03, P = 0.025) and metabolically unhealthy obesity (MUO) (OR 3.30, 95% CI 1.64-6.64, P = 0.001) were significantly correlated with aICAS, but not metabolically healthy obesity (MHO). Subgroup analysis further confirmed the association between MU and aICAS risk only in men (P for interaction = 0.042).

CONCLUSIONS

MU defined by the new criterion was significantly associated with aICAS, especially with moderate-to-severe aICAS. This novel criterion effectively identifies individuals with a high prevalence of aICAS among populations with obesity, which could be crucial for stroke prevention.

Sex hormone-dependent host-microbiome interactions and cardiovascular risk (XCVD): design of a longitudinal multi-omics cohort study

INTRODUCTION

Cardiovascular diseases (CVDs) present differently in women and men, influenced by host-microbiome interactions. The roles of sex hormones in CVD outcomes and gut microbiome in modifying these effects are poorly understood. The XCVD study examines gut microbiome mediation of sex hormone effects on CVD risk markers by observing transgender participants undergoing gender-affirming hormone therapy (GAHT), with findings expected to extrapolate to cisgender populations.

METHODS AND ANALYSES

This observational, longitudinal cohort study includes baseline, 1- and 2-year follow-ups with transgender participants beginning GAHT. It involves comprehensive phenotyping and microbiome genotyping, integrating computational analyses of high-dimensional data. Microbial diversity will be assessed using gut, skin, and oral samples via 16S rRNA and shotgun metagenomic sequencing of gut samples. Blood measurements will include sex hormones, CVD risk markers, cardiometabolic parameters, cytokines, and immune cell counts. Hair samples will be analysed for cortisol. Participants will complete online questionnaires on physical activity, mental health, stress, quality of life, fatigue, sleep, pain, and gender dysphoria, tracking medication use and diet to control for confounders. Statistical analyses will integrate phenomic, lifestyle, and multi-omic data to model health effects, testing gut microbiome mediation of CVD risk as the endocrine environment shifts between that typical for cisgender men to women and vice versa.

ETHICS AND DISSEMINATION

The study adheres to Good Clinical Practice and the Declaration of Helsinki. The protocol was approved by the Charité Ethical Committee (EA1/339/21). Signed informed consent will be obtained. Results will be published in peer-reviewed journals and conferences and shared as accessible summaries for participants, community groups, and the public, with participants able to view their data securely after public and patient involvement review for accessibility.

TRIAL REGISTRATION NUMBER

The XCVD study was registered on ClinicalTrials.gov (NCT05334888) as 'Sex-differential host-microbiome CVD risk - a longitudinal cohort approach (XCVD)" on 4 April 2022. Data set link can be found at https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05334888.

Elevated Fasting C-Peptide Levels Correlate with Increased 10-Year Risk of Atherosclerotic Cardiovascular Disease in Newly Diagnosed Type 2 Diabetes Patients

Purpose

This study aims to analyze the impact of serum C-peptide levels in patients with newly diagnosed type 2 diabetes (T2DM) on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD).

Patients and Methods

A total of 1923 patients with newly diagnosed T2DM were selected and categorized into four groups based on the interquartile range of fasting C-peptide (FCP) levels: Q1 group (FCP≤0.568 ng/mL), Q2 group (0.568 < FCP≤0.751 ng/mL), Q3 group (0.751 < FCP≤0.980 ng/mL), and Q4 group (FCP > 0.980 ng/mL). Clinical data were collected, and the China-PAR model was employed to evaluate the risk score of ASCVD within 10 years. Additionally, the correlation between FCP levels and the risk of ASCVD was analyzed.

Results

As the quartiles of FCP increased, the 10-year ASCVD risk exhibited a gradual increase. The risk score in the FCP > 0.980 ng/mL group was significantly higher than that in the other groups, with noted differences related to gender and weight. Multiple linear regression analysis indicated that, even after adjusting for confounding factors such as gender, age, body mass index (BMI), and glycosylated hemoglobin, FCP levels remained a positive predictor of the 10-year ASCVD risk.

Conclusion

High FCP levels are identified as a risk factor for ASCVD within 10 years in patients with newly diagnosed T2DM.

Obesity modifies the association between abnormal glucose metabolism and atrial fibrillation in older adults: a community-based longitudinal and prospective cohort study

OBJECTIVE

To investigate the modifying role of obesity in the association between abnormal glucose metabolism and atrial fibrillation (AF) risk in older individuals.

METHODS

From April 2007 to November 2011, 11,663 participants aged ≥60 years were enrolled in the Shandong area. Glucose metabolic status was determined using fasting plasma glucose and hemoglobin A1c levels, and obesity was determined using body mass index (BMI), waist-to-hip ratio (WHR), and visceral fat area (VFA). Obesity-associated metabolic activities were assessed using the adiponectin-to-leptin ratio (ALR), galectin-3, and triglyceride-glucose index (TyG). New-onset AF was diagnosed by ICD-10.

RESULTS

During an average of 11.1 years of follow-up, 1343 participants developed AF. AF risks were higher in those with prediabetes, uncontrolled diabetes, and well-controlled diabetes than with normoglycemia. The hazard ratios were decreased by 14.79%, 40.29%, and 25.23% in those with prediabetes; 31.44%, 53.56%, and 41.90% in those with uncontrolled diabetes; and 21.16%, 42.38%, and 27.59% in those with well-controlled diabetes after adjusting for BMI, WHR, and VFA, respectively. The population-attributable risk percentages of general obesity, central obesity, and high VFA for new-onset AF were 10.43%, 34.78%, and 31.30%, respectively. ALR, galectin-3, and TyG significantly mediated the association of BMI, WHR, and VFA with AF risk (all Padj. < 0.001).

CONCLUSION

Obesity mediates the association between abnormal glucose metabolism and AF risk in older individuals. WHR is a more effective modifier than BMI and VFA for moderating the association. ALR, TyG, and galectin-3 mediate the moderating effect of obesity on the association between abnormal glucose metabolism and AF risk.

Beyond Traditional Body Composition Metrics: Load-Capacity Indices Emerge as Predictors of Cardiometabolic Outcomes-A Systematic Review and Meta-Analysis

The adaptive and independent interrelationships between different body composition components have been identified as crucial determinants of disease risk. On the basis of this concept, the load-capacity model of body composition, which utilizes measurements obtained through nonanthropometric techniques such as dual-energy X-ray absorptiometry, was proposed. This model is typically operationalized as the ratio of metabolic load (adipose mass) to metabolic capacity (lean mass). In recent years, a series of load-capacity indices (LCIs) have been utilized to identify abnormal body composition phenotypes such as sarcopenic obesity (SO) and to predict the risk of metabolic, cardiovascular, and cognitive disorders. In this review, we comprehensively review the characteristics of different LCIs used in previous studies, with a specific focus on their applications, especially in identifying SO and predicting cardiometabolic outcomes. A systematic literature search was performed using PubMed, MEDLINE, PsycINFO, Embase, and the Cochrane Library. Two meta-analyses were conducted to 1) estimate the overall prevalence of SO mapped by LCIs, and 2) assess the association of LCIs with cardiometabolic outcomes. A total of 48 studies (all observational) were included, comprising 22 different LCIs. Ten studies were included in the meta-analysis of SO prevalence, yielding a pooled prevalence of 14.5% [95% confidence interval (CI): 9.4%, 21.6%]. Seventeen studies were included in the meta-analysis of the association between LCIs and adverse cardiometabolic outcomes, which showed a significant association between higher LCI values and increased risk (odds ratio = 2.22; 95% CI: 1.81, 2.72) of cardiometabolic diseases (e.g. diabetes and metabolic syndrome). These findings suggest that the load-capacity model of body composition could be particularly useful in the identification of SO cases and prediction of cardiometabolic risk. Future longitudinal studies are needed to validate the association of LCIs with chronic cardiometabolic and neurodegenerative diseases. This systematic review and meta-analysis has been registered with PROSPERO (CRD42024457750).

Connecting the Dots: Gender, Sexuality, and Societal Influences on Cognitive Aging and Alzheimer's Disease

Alzheimer's disease (AD) has many etiologies and the impact of gender on AD changes throughout time. As a consequence of advancements in precision medical procedures and methodology, Alzheimer's disease is now better understood and treated. Several risk factors may be addressed to lower one's chances of developing Alzheimer's disease or associated dementia (ADRD). The presence of amyloid-α protein senile plaques, intracellular tau protein neurofibrillary tangles (NfTs), neurodegeneration, and neuropsychiatric symptoms (NPS) characterizes Alzheimer's disease. NPS is common in persons with Alzheimer's disease dementia, although its presentation varies widely. Gender differences might explain this clinical variability. The fundamental goal of this review is to 1) emphasize the function of old age, sex, and gender in the development of Alzheimer's disease, dementia, and ADRD, and 2) explain the importance of sexual hormones, education, and APOE (Apolipoprotein E) status. This is a narrative summary of new ideas and concepts on the differences in the chance of developing dementia or Alzheimer's disease between men and women. A more thorough examination of risk and protective variables in both men and women might hasten research into the epidemiology of neurological illnesses such as dementia and Alzheimer's disease. Similarly, future preventive efforts should target men and women separately.

Sitting time at work and cardiovascular disease risk-a longitudinal analysis of the Study on Mental Health at Work (S-MGA)

PURPOSE

This study analyzed longitudinal data to examine whether occupational sitting time is associated with increases in body mass index (BMI) and five-year cardiovascular disease (CVD) risk.

METHODS

We included 2,000 employed men and women (aged 31-60) from the German Study on Mental Health at Work (S-MGA) for a BMI analysis and 1,635 participants free of CVD at baseline (2011/2012) for a CVD analysis. Occupational sitting time was categorized into five groups (< 5, 5 to < 15, 15 to < 25, 25 to < 35, and ≥ 35 h per week). BMI change was measured from baseline (2011/2012) to follow-up (2017). Incident CVD included hypertension, heart disease, myocardial infarction, and stroke (all self-reported). Multiple linear regression examined the association between sitting time and BMI change, while modified Poisson regression analyzed CVD incidence, adjusting for age, sex, occupation, shift work, leisure activity, and smoking by sex. Covariates were self-reported.

RESULTS

Over five years, the average BMI change was 0.49 (SD 1.9). We found no association between baseline occupational sitting time and BMI changes, with consistent results in sensitivity analyses. During this period, 245 participants developed cardiovascular disease. There was no increased risk of CVD among those with more sitting time compared to less. No differences in risk were found between women and men.

CONCLUSION

There was no association between occupational sitting time and five-year changes in BMI or incident CVD.

Sex Differences in Cardiovascular-Kidney-Metabolic Syndrome: 30-Year US Trends and Mortality Risks-Brief Report

BACKGROUND

The American Heart Association recently published guidelines on how to clinically identify and categorize individuals with cardiovascular-kidney-metabolic (CKM) syndrome. The extent to which CKM syndrome prevalence and prognosis differ by sex remains unknown. This study aimed to examine the impact of sex on trends in prevalence over 30 years and the long-term prognosis of CKM syndrome in the United States.

METHODS

We analyzed nationally representative National Health and Nutrition Examination Survey 1988 to 2018 data collected from 33 868 US adults (aged ≥20 years) who were under surveillance for all-cause mortality through December 31, 2019. We examined the sex-specific prevalence of CKM syndrome and sex-specific CKM associations with all-cause mortality.

RESULTS

Of the 33 868 adults studied, the mean±SD age was 48.4±18.3 years with 52% women and 56% non-White. Overall prevalence of CKM syndrome increased steadily from 1988 to 2018 in both sexes, with a larger temporal rise in prevalent stage 3 CKM seen for men (from 18.9% to 22.4%) compared with women (from 13.9% to 15.2%). Over a median follow-up of 13.3 years, there were 8745 deaths. In the multivariable Cox regression analysis, worsening CKM severity was associated with all-cause mortality (P<0.001 for both sexes), with greater magnitudes of risk seen in women (hazards ratio, 1.24-3.33) compared with men (hazards ratio, 0.85-2.60) across all stages (likelihood ratio test χ2, 19.0; Pinteraction<0.001); results were similar for cardiovascular mortality (likelihood ratio test χ2, 22.3; Pinteraction<0.001).

CONCLUSIONS

Women, compared with men, exhibited a lower prevalence of CKM stage 3 but experienced excess mortality risk across the spectrum of multisystem CKM dysfunction. These findings underscore the importance of identifying mechanisms underlying joint cardiovascular, kidney, and metabolic system pathophysiology to close a potentially widening sex disparities gap in multiorgan disease risk.

Combined association of physical activity and depressive symptoms with cardiometabolic risk factors in Chilean adults

Cardiometabolic risk factors such as obesity, raised blood pressure, high blood glucose and dyslipidemia are emerging health concerns worldwide. Therefore, the aim of this study was to estimate the combined association between physical activity and depressive symptoms with cardiometabolic risk factors in Chilean adults. Data was obtained from the National Health Survey of Chile 2016-2017, with a sample of 5995 adult participants. Assessment of Physical activity and depressive symptoms were done using the Global Physical Activity Questionnaire (GPAQ) and the CIDI ShortForm (CIDI-SF), respectively. Multivariable logistic regression was performed to estimate the combined association of physical activity and depressive symptoms with cardiometabolic risk factors. Participants in the category ≥ 150 min/Depressive symptoms had the highest prevalence of overweight (OR: 1.55, 95% CI: 1.17-2.05), obesity (OR: 1.97, 95% CI: 1.49-2.59) and high waist circumference (OR: 1.63, 95% CI: 1.39-1.92). Participants in the < 150 min/No depressive symptoms category had a lower prevalence of overweight/obesity (OR: 0.68, 95% CI: 0.60-0.78) and a 25% reduced high triglycerides prevalence, in comparison with the active category with no depressive symptoms. There is a positive association between depressive symptoms and overweight, obesity and waist circumference among subjects that complete physical activity recommendations but have depressive symptoms.

An integrated view of the pathophysiological crosstalk between adipose tissue, bone and cardiovascular system in men and women

BACKGROUND

Obesity, bone-related and cardiovascular diseases (CVD) are among the leading global health concerns. Growing evidence suggests that these conditions share common pathophysiological pathways and disease outcomes. PATHOGENETIC INTERACTIONS OF OBESITY, CVD AND BONE-RELATED DISEASES: Obesity is a well-established risk factor for atherosclerotic CVD (ASCVD), as dysfunctional ectopic adipose tissue may produce endocrine/paracrine hormones modulating metabolic processes and inflammation, predisposing to ASCVD. Although obesityhas been considered a protective factor for bone loss, it may lead to osteoporosis development and increased fracture risk at specific sites. Biological and epidemiological evidence has demonstrated the existence of a dynamic relationship between ASCVD and osteoporosis, since atherosclerotic calcification and bone mineralization share common pathophysiological mechanisms. Therefore, addressing ASCVD, obesity, and bone-related diseases requires multiple-level approach, which involve accurate screening, lifestyle modifications and pharmacological interventions.The current evidence about the pathophysiological relationships between obesity, bone-related diseases and ASCVD is discussed herein, highlighting common risk factors, proposed biomolecular mechanisms, clinical outcomes, lifestyle changes and pharmacological treatments.

CONCLUSIONS

As populations become increasingly older and obese, understanding the correlation within this triad highlights an unmet clinical need. Applying this knowledge would help to reduce both societal and individual costs, while supporting the development of novel preventive, diagnostic and therapeutic strategies to reduce morbidity and disability associated with cardio-metabolic and bone-related diseases.

Interaction between sex and one-hour post-load glucose on metabolic syndrome and its components among Chinese people at high risk of diabetes

BACKGROUND

Recently, International Diabetes Federation position statement has adopted one-hour post-load glucose (1hPG) ≥ 8.6 mmol/L for diagnosing intermediate hyperglycemia. We aimed to assess the association of 1hPG ≥ 8.6 mmol/L with metabolic syndrome (MetS) and its components, as well as interaction between sex and 1hPG ≥ 8.6 mmol/L on MetS and its components in Chinese people at high risk of diabetes.

METHODS

The cross-sectional study was conducted in DaQing city of HeiLongJiang Province, China between August, 2023 and January, 2024. Eligible individuals with fasting glucose of 5.6-6.9 mmol/L and age of 25-55 years in health checkup data in the year of 2023 or with at least one risk factor of diabetes were invited to receive the oral glucose tolerance test and biochemical examinations. Individuals with self-reported presence of diabetes or usage of glucose-lowering medication were excluded. MetS was defined as presence of at least three of the five components according to the Chinese Diabetes Society criteria. Logistic regression was performed to evaluate the association of 1hPG ≥ 8.6 mmol/L with MetS and its components. Additive interaction was estimated using the relative excess risk due to interaction, attributable proportion due to interaction (AP), and synergy index.

RESULTS

A total of 2419 subjects comprising 1465 men (60.6%) with a mean age of 45.77 ± 6.20 years were included, and the prevalence of MetS was 46.8%, with 59.7% in men and 27.1% in women. 1hPG ≥ 8.6 mmol/L was associated with MetS (aOR = 4.40, 95% CI 3.26-6.01), elevated blood pressure (aOR = 1.46, 95% CI 1.13-1.89), hyperglycemia (aOR = 15.46, 95% CI 11.56-20.98), and reduced HDL-C (aOR = 1.51, 95% CI 1.07-2.15) in the overall population, whereas no significant association between 1hPG ≥ 8.6 mmol/L and elevated blood pressure in men (aOR = 1.36, 95% CI 0.97-1.91) or dyslipidemia in women (elevated TG: aOR = 0.81, 95% CI 0.47-1.39; reduced HDL-C: aOR = 1.08, 95% CI 0.49-2.37). Additive interaction effect between sex and 1hPG ≥ 8.6 mmol/L on MetS was observed, with 31% attributed to the interaction effect between men and 1hPG ≥ 8.6 mmol/L (AP = 0.31, 95% CI 0.06-0.49).

CONCLUSIONS

There was an additive interaction effect between sex and 1hPG on MetS among Chinese people at high risk of diabetes. 1hPG test and sex-specific strategies should be taken into consideration in cardiometabolic disorder identification and management.

The gender and age perspectives of allostatic load

The role of chronic stress in the development of chronic diseases, especially multimorbidity, through the pathways of increasing allostatic load, and finally, allostatic overload (the state when a compensatory mechanism is likely to fail) is being emphasized. However, allostatic load is a dynamic measure that changes depending on sex, gender, age, level and type of stress, experience of a stressful situation, and coping behaviors. Many other factors such as race, ethnicity, working environment, lifestyle, and circadian rhythm of sleep are also important. The aim of this paper was to synthesize the available information on allostatic load differences, especially those connected to sex/gender and age, and to provide a model for the future study of allostatic load, with a focus on these differences. By carefully studying allostatic load factors, we realized that many studies do not take this allostatic load difference into account in the analysis methods. In this paper, we also support the idea of further research to develop new allostatic load analysis strategies that will include all knowledge about sex/gender differences and that will, in more detail, explain numerous changeable social and educational factors that are currently accepted as biological ones. Furthermore, specific allostatic load biomarkers are expressed differently in different age groups, indicating that the discrepancies cannot be attributed solely to sex/gender disparities. This kind of approach can be valuable, not only for better explaining the differences in the frequency and age of onset of chronic diseases and multimorbidity, but also for the potential planning and development of preventive actions based on the aforementioned sex/gender and age disaparities, in order to prevent the most frequent diseases and to establish specific biomarker cut-off values for each sex/gender and age group.

Non-exercise Estimated Cardiorespiratory Fitness and Mortality Among Adults With Hypertension

BACKGROUND

The non-exercise estimated cardiorespiratory fitness (eCRF) has been recognized as an important predictor of mortality among the general population. This study sought to evaluate the relationship between eCRF and mortality from all causes, cardiovascular disease (CVD), and cancer in hypertensive adults.

METHODS

We included 27,437 adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) III and 10 NHANES cycles from 1999 to 2018. Multivariate Cox proportional hazard models were used to assess the hazard ratios and 95% confidence intervals (CIs) of eCRF for mortality.

RESULTS

A total of 8,023 deaths were recorded throughout a median 8.6-year follow-up, including 2,338 from CVD, and 1,761 from cancer. The eCRF with per 1 metabolic equivalent increase was linked to decreased risk of all-cause (adjusted HR 0.78, 95% CI: 0.75-0.81) and CVD mortality (adjusted HR 0.79, 95% CI: 0.74-0.84), rather than cancer mortality (adjusted HR 0.94, 95% CI: 0.86-1.03). Moreover, a stronger protective effect of eCRF was observed for females (HR 0.66 (95% CI: 0.62-0.72) versus HR 0.78 (95% CI: 0.73-0.83), Pinteraction < 0.001 for all-cause mortality; HR 0.70 (95% CI: 0.61-0.80;) versus HR 0.82 (95% CI: 0.73-0.92), Pinteraction = 0.026 for CVD mortality) compared with males. Findings did not significantly differ in subgroup analyses and sensitivity analyses.

CONCLUSIONS

Among adults with hypertension, eCRF was inversely related to all-cause and CVD mortality, but not cancer mortality. A significant interaction effect existed between sex and eCRF. Further studies are needed to verify this association in different populations.

Unique cardiometabolic factors in women that contribute to modified cardiovascular disease risk

Major risk factors of cardiovascular disease (CVD) include hypertension, obesity, diabetes mellitus and metabolic syndrome; all of which are considered inflammatory conditions. Women are disproportionately affected by inflammatory conditions, with sex differences emerging as early as adolescence. Hormonal fluctuations associated with reproductive events such as menarche, pregnancy and menopause, are hypothesized to promote a pro-inflammatory state in women. Moreover, women who have experienced inflammatory-type conditions such as polycystic ovarian syndrome (PCOS), gestational diabetes or pre-eclampsia, have a cardiometabolic phenotype that pre-disposes to increased risk of myocardial infarction, stroke and coronary heart disease. Women with no notable CVD risk factors are often relatively protected from CVD pre-menopause; but overtake men in risk of major cardiovascular events when the cardiovascular protective effects of oestrogen begin to wane. Sex differences and female-specific factors have long been considered challenging to study and this has led to an underrepresentation of females in clinical trials and lack of female-specific data from pre-clinical studies. However, there is now a clear prerogative to include females at all stages of research, despite inherent complexities and potential variability in data. This review explores recent advancements in our understanding of CVD in women. We summarise the underlying factors unique to women that can promote CVD risk factors, ultimately contributing to CVD burden and the emerging therapies aimed to combat this.

Specificities of Myocardial Infarction and Heart Failure in Women

Substantial evidence from previous clinical studies, randomized trials, and patient registries confirms the existence of significant differences in cardiac morphology, pathophysiology, prevalence of specific coronary artery disease (CAD), and clinical course of myocardial infarction (MI) between men and women. The aim of this review is to investigate the impact of sex or gender on the development and clinical course of MI, the mechanisms and features of left ventricular (LV) remodeling, and heart failure (HF). The main sex-related difference in post-MI LV remodeling is adverse LV dilatation in males versus concentric LV remodeling or concentric LV hypertrophy in females. In addition, women have a higher incidence of microvascular dysfunction, which manifests as impaired coronary flow reserve, distal embolism, and a higher prevalence of the no-reflow phenomenon. Consequently, impaired myocardial perfusion after MI is more common in women than in men. Regardless of age or other comorbidities, the incidence of reinfarction, hospitalization for HF, and mortality is significantly higher in females. There is therefore a "sex paradox": despite the lower prevalence of obstructive CAD and HF with reduced ejection fraction (HFrEF), women have a higher mortality rate after MI. Different characteristics of the coronary network, such as plaque formation, microvascular dysfunction, and endothelial inflammation, as well as the prolonged time to optimal coronary flow restoration, secondary mitral regurgitation, and pulmonary vascular dysfunction, lead to a worse outcome in females. A better understanding of the mechanisms responsible for MI occurrence, LV remodeling, and HF in men and women would contribute to optimized patient therapy that would benefit both sexes.

Comparison of seven models for the progression patterns of multiple chronic conditions in longitudinal studies

Introduction

Studies investigating the relationship between patterns of multimorbidity and risk of a new condition have typically defined the patterns at a baseline time and used Kaplan-Meier (KM) or Cox proportional hazards regression. These methods do not consider the competing risk of death or the changes in the patterns of conditions over time. This study illustrates how these methodological limitations can be overcome in the setting of progression from cardiometabolic conditions to dementia.

Methods

Data from 11 930 women who participated in the Australian Longitudinal Study on Women's Health were used to define patterns of diabetes, heart disease and stroke and estimate the cumulative incidence or HRs of subsequent dementia. Seven methods were compared. For cumulative incidence these were KM method, cumulative incidence function (CIF) (to account for the competing risk of death) and multistate model with Aalen-Johansen estimates (to account also for the progression of conditions over time). For HRs, the corresponding methods were Cox model and Fine and Gray model (for sub-HRs) with the cardiometabolic patterns treated as time-invariant (from baseline) or as time-varying predictors.

Results

The estimated cumulative incidence of dementia using the KM method declined when the competing risk of death was considered. For example, for women with no cardiometabolic condition at baseline, the KM and CIF estimates were 35.7% (95% CI 34.6%, 36.8%) and 27.3% (26.4%, 28.2%) but these women may have developed cardiometabolic conditions during the study which would increase their risk. The Aalen-Johansen multistate estimate for women with no cardiometabolic condition over the whole study period was 11.0% (10.4%, 11.7%). Comparing models to estimate HRs, the estimates in the Fine and Gray models were lower than those in the Cox models.

Conclusions

Multistate and time-varying survival analysis models should be used to study the natural development of multimorbidity.

Incidence trends and specific risk factors of ischemic heart disease and stroke: An ecological analysis based on the Global Burden of Disease 2019

Distribution of risk factors for cardiovascular diseases has been changing globally, which may account for the discrepant temporal trends of ischemic heart disease (IHD) and stroke. To test the hypothesis and identify potential contributing factors, we designed an ecological study based on the GDB-2019 data and extracted age-standardized incidence rates (ASIRs) of IHD and stroke, and summary exposure values (SEVs) of 87 attributable factors. A declining trend was observed for ASIRs of stroke (globally from 181.4 to 150.8/100,000 during 1990 and 2019, with an average annual percentage change of -0.64%) and IHD (globally from 316.4 to 262.4/100,000, with an average annual percentage change of -0.67%). However, the ASIR of IHD increased in Eastern Sub-Saharan Africa, Western Sub-Saharan Africa, East Asia, Central Asia, and Oceania, particularly in Uzbekistan and other 55 countries experiencing rapid socioeconomic translation. Eight factors, i.e. diet high in trans-fatty acids, diet low in calcium, high body-mass index, household air pollution from solid fuels, non-exclusive breastfeeding, occupational ergonomic factors, Vitamin A deficiency, and occupational exposure to particulate matter, gases, and fumes, were reversely associated with the ASIR of IHD and stroke at the country level. Ecological trend analysis also illustrated significant reverse associations of the factors with the ASIRs of IHD and stroke in in Western Sub-Saharan Africa, East Asia, and Oceania, but consistent associations in countries classified by the World Bank income levels. The results indicate the contributions of altered exposures to the eight factors in the discrepant trends of IHD and stroke across regions and countries, and suggest the determinant role of socioeconomic development in covariant of the risk factors with the incidences of IHD and stroke.

Carotid Intima-Media Thickness in Surgically or Conservatively Managed Patients With Primary Hyperparathyroidism

CONTEXT

Current evidence of cardiovascular (CV) risk in primary hyperparathyroidism (PHPT) is still inconsistent.

OBJECTIVE

To prospectively investigate changes of early atherosclerosis in patients with PHPT undergoing parathyroidectomy (PTx) or conservative management, according to consensus criteria.

METHODS

Biochemical parameters of PHPT, CV risk factors (systolic and diastolic blood pressure, cholesterol [total, high-density, and low-density], triglyceride, HbA1c, HOMA-IR), and carotid intima-media thickness (IMT) and plaque were assessed in 52 consecutive postmenopausal PHPT patients both at baseline and ≥ 24 months after surgery (PTx, n = 22) or conservative management (non-PTx, n = 30).

RESULTS

At baseline, PTx and non-PTx showed comparable age, BMI, renal function, and 25(OH)D levels, and did not differ for CV risk factors, IMT and plaques, or for prevalence of smoking, diabetes mellitus, or antihypertensive or statin therapy, while all parameters characterizing PHPT differed. Follow-up duration in PTx was longer than in non-PTx (P = .004). Parameters characterizing PHPT significantly improved ≥ 24 months after surgery, whereas in non-PTx serum phosphate slightly decreased and parathyroid hormone increased. Systolic and diastolic blood pressure increased at follow-up in both groups, while other CV risk factors did not significantly vary. In PTx, IMT did not significantly vary after surgery (0.85 ± 0.14 to 0.89 ± 0.22 mm, P = .366), whereas it significantly increased in non-PTx (0.80 ± 0.18 to 0.93 ± 0.23 mm, P = .008), even adjusting for blood pressure. Plaque prevalence and incidence did not significantly differ in the 2 groups.

CONCLUSION

Our results suggest that in postmenopausal patients with PHPT, subclinical atherosclerosis could be halted by PTx, whereas it worsens over time in nonoperated patients with milder disease.

Relationship between serum vitamin D levels and the atherogenic index of plasma: a study based on NHANES database 2011-2018

Objective

This study aims to investigate the relationship between serum vitamin D levels and the atherogenic index of plasma (AIP) in individuals aged 20 years and above, as well as analyze potential influencing factors.

Methods

A total of 9,637 participants aged 20 years and above from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2018 were included in this study. The AIP was calculated using the formula log[triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C)]. Due to the skewed distribution of serum vitamin D levels in the study population, a normal transformation was performed. Weighted multivariate linear regression models were used to assess the linear relationship between the transformed serum vitamin D levels and AIP. Subgroup analysis was conducted by stratifying the data based on age, gender, and race to evaluate the stability of the relationship between serum vitamin D levels and AIP in different populations. In addition, a smooth curve fitting and generalized linear models were employed to examine the nonlinear relationship between serum vitamin D levels and AIP.

Results

After controlling for confounding factors, the multivariate linear regression analysis revealed a negative correlation between serum vitamin D levels and AIP [β = -0.0065, 95% CI: (-0.0106, -0.0024)]. This negative correlation was significant in male participants [β = -0.0077, 95% CI: (-0.0142, -0.0011)], Non-Hispanic Black participants [β = -0.0135, 95% CI: (-0.0211, -0.0059)], as well as participants aged 40-50 [β = -0.0124, 95% CI: (-0.0226, -0.0022)] and 60-70 [β = -0.0118, 95% CI: (-0.0214, -0.0023)]. Furthermore, a nonlinear relationship and saturation effect were observed between the transformed serum vitamin D levels and AIP, with a turning point at 8.5617 nmol/L.

Conclusion

Our study revealed a significant negative correlation and saturation effect between serum vitamin D levels and AIP.

Estimated glucose disposal rate, high sensitivity C-reactive protein and cardiometabolic multimorbidity in middle-aged and older Chinese adults: A nationwide prospective cohort study

AIM

To explore the separate and joint association of estimated glucose disposal rate (eGDR) and high-sensitivity C-reactive protein (hsCRP) with cardiometabolic multimorbidity (CMM).

METHODS

A total of 6900 participants aged 45 years or older with available data on eGDR and hsCRP and without cardiometabolic diseases at baseline from the China Health and Retirement Longitudinal Study were included. CMM was defined as the coexistence of two or more cardiometabolic diseases, including heart diseases, stroke, and diabetes.

RESULTS

During a median follow-up of 9.0 years, 464 (6.7 %) participants developed CMM. Low eGDR and high hsCRP separately and jointly increased the risk of CMM. The adjusted hazard ratio (HR) was 1.67 (95 % confidence interval [CI] 1.33-2.09) for low eGDR versus high eGDR, 1.43 (95 % CI 1.12-1.82) for high hsCRP versus low hsCRP) and 2.40 (95 % CI 1.77-3.27) for low eGDR plus high hsCRP versus high eGDR plus low hsCRP. The C-statistic, discriminatory power and risk reclassification significantly improved with the addition of combined eGDR and hsCRP for CMM (P < 0.001).

CONCLUSIONS

Low eGDR and high hsCRP were individually and jointly associated with increased risk of incident CMM. The findings highlighted the importance of joint evaluation of eGDR and hsCRP for primary prevention of CMM.

Diabesity alters the protective effects of estrogens on endothelial function through adipose tissue secretome

Estrogens have a well-known protective role in the development of the metabolic syndrome. Nevertheless, recent epidemiological data question the cardioprotective effect of estrogens in obese and diabetic women. In this context, white adipose tissue (WAT) becomes dysfunctional, which has an impact on the cardiovascular system. The aim of the study was to elucidate the role of 17β-estradiol (E2) in the interplay between adipose tissue and endothelial function in an animal model of diabesity. We used ZDF (fa/fa) female rats subjected to ovariectomy (OVA), OVA + E2 or sham operated, as well as non-obese non-diabetic ZDF (fa/+) rats. Endothelial function and vascular remodeling markers were assessed in the aorta, while mitochondrial function, oxidative stress, and adiponectin production were analyzed in gonadal WAT. Conditioned media from gonadal WAT explants were used to assess the effects of WAT secretome on HUVEC. Additionally, the adiponectin receptor agonist AdipoRON and E2 were utilized to examine potential interactions. Ovariectomy ameliorated the WAT dysfunction associated to the obese and diabetic state and promoted adiponectin secretion, effects that were linked to a reduction of endothelial dysfunction and inflammatory markers in the aorta of OVA rats and in HUVEC treated with OVA-conditioned media. Our findings provide evidence supporting the idea that in the context of obesity and diabetes, ovariectomy improves WAT secretome and positively impacts endothelial function, suggesting a detrimental role for E2. Additionally, our results point to adiponectin as the primary driver of the effects exerted by ovariectomy on the adipovascular axis.