European journal of preventive cardiology最新文献

Aims: No cardiovascular risk prediction model dedicated to individuals aged ≥70 years with diabetes is currently recommended by the European Society of Cardiology. We aimed to develop a new model, CArdiovascular Risk Estimation-Diabetes Mellitus (CARE-DM), to predict the risk of cardiovascular disease (CVD) in older adults with type 2 diabetes.

Methods and results: We developed a model to predict the risk of incident CVD in participants aged ≥65 years with diabetes using data from four population-based prospective cohorts, accounting for the competing risk of non-cardiovascular death. Pre-specified predictors were age, gender, smoking status, alcohol consumption, body mass index, total and HDL cholesterol, use of antihypertensive, cholesterol-lowering and glucose-lowering medication, diabetes duration, and glycated haemoglobin. We assessed model performance using measures of calibration and discrimination. We used a 10-fold cross-validation and a bootstrapping approach to correct estimates for optimism and conducted an internal-external cross-validation. A total of 6943 participants (median age 72 years, 56% women) with diabetes were included in the model development. Over a median follow-up of 6.3 (interquartile range 3.7, 7.2) years, 1204 (17.3%) participants experienced a CVD event. Internal validation with optimism correction showed adequate model performance with a C-index of 0.65 (95% confidence interval 0.63-0.67), an observed-to-expected ratio of 1.01 (0.95-1.08), and a calibration slope of 1.13 (0.95-1.31) at 5 years.

Conclusion: The new CARE-DM model allows prediction of the incident CVD risk in older adults with type 2 diabetes. Independent external validation should be conducted to confirm the model's performance before implementation in clinical practice.

Aim: Cardiovascular (CV) risk assessment in transgender individuals remains poorly understood. Emerging data suggest a potential increase in CV risk associated with gender-affirming hormone therapy(GAHT). Conventional tools such as coronary artery calcium(CAC) scoring may underestimate risk in this young population. Advanced imaging techniques (coronary computed tomography angiography CCTA and 3-dimensional supra-aortic trunk ultrasonography SATUS) may provide more accurate evaluation, but their relevance in transgender cohorts has not yet been established. We aimed to assess early CV risk modification of GAHT using several innovative imaging techniques.

Methods: We conducted a prospective, single-center study at Bordeaux University Hospital, enrolling transgender individuals initiating or continuing GAHT. Participants undergone clinical and biological assessment and CV imaging(CAC, CCTA, SATUS) at baseline and after 18months.

Results: Thirty-four participants (17transmen (TM), 17transwomen (TW) were included. At baseline, TM were younger than TW (22.7±5.3 vs 29.7±9.7years,p=0.008), had higher HDLc (1.36 vs 1.18mmol/L,p=0.01), and higher smoking prevalence (70.6% vs 11.8%, p=0.001). Both groups had a CAC score and carotid plaque volume of zero. During follow-up, TW showed a modest increase in carotid plaque volume and CAC scores, whereas TM showed no change. Progression of coronary plaque volume was observed in 70% of TW compared with 22% of TM, indicating a clear, although non-significant, trend toward greater atherosclerotic development in TW.

Conclusion: This pilot study suggests a more pronounced progression of atherosclerosis in TW undergoing GAHT, detectable particularly through CCTA. These findings support refined CV monitoring and highlight the need for larger, long-term studies to guide preventive strategies in transgender populations.

Metabolic and bariatric surgery (MBS) has long been considered the most effective long-term treatment for severe obesity and its associated comorbidities, including type-2 diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, and cardiovascular disease. Beyond weight loss, MBS has been associated with improved glycemic and metabolic control, lower apnea burden, reduced risk of major adverse cardiovascular events, and improved overall survival. In the last few years, the use of safe and effective weight-loss medications has revolutionized the management of patients with obesity, and may in the future influence referral patterns for MBS. Future research is therefore warranted to clarify the integration between MBS and these novel pharmacological opportunities, with the aim of optimizing patient selection and therapeutic pathways. The aim of this narrative review is therefore to describe the role of MBS in contemporary clinical practice, considering the evolving landscape of pharmacological approaches to treat patients with obesity.