Elevated low-density lipoprotein (LDL) cholesterol is a major modifiable risk factor for cardiovascular disease (CVD). While global trends in LDL-attributable CVD have been previously reported, disparities across sociodemographic development levels remain insufficiently explored.
Objective
To assess global, regional, and SDI-specific trends in the CVD burden attributable to high LDL cholesterol from 1990 to 2021.
Methods
We utilized Global Burden of Disease (GBD) 2021 data to evaluate CVD mortality and disability-adjusted life years (DALYs) attributable to high LDL cholesterol. Trends were assessed using annual percentage change (APC) in age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR), and age-standardized years lived with disability (ASYLD) by Socio-demographic Index (SDI), sex, and location.
Results
From 1990 to 2021, global ASMR and ASDR attributable to high LDL cholesterol declined. In 2021, ASMR and ASDR were lowest in high SDI regions. Israel recorded the largest decrease in APC for both ASMR and ASDR, while Lesotho exhibited the highest increase. Over the same period, Singapore showed the greatest decline in APC of ASYLD, whereas Tanzania had the most pronounced increase. The greatest reductions in APC of ASMR and ASDR from 1990 to 2021 were observed in high SDI countries, particularly during the decade 2000–2010. Females consistently showed declining APCs of ASMR across all SDI quintiles, whereas in males, APCs declined only in high and high-middle SDI countries.
Conclusion
Persistent disparities in CVD burden attributable to high LDL across SDI quintiles highlight the need for equitable, tailored lipid-lowering and cardiometabolic prevention strategies.
{"title":"Global Trends and Sociodemographic Disparities in LDL-Attributable Cardiovascular Disease: GBD 2021 Analysis (1990–2021)","authors":"Rohan Raj , Ujjwal Mishra , Nikhil Jain , Kanishka Kumar Awasthi","doi":"10.1016/j.ahj.2025.07.047","DOIUrl":"10.1016/j.ahj.2025.07.047","url":null,"abstract":"<div><h3>Background</h3><div>Elevated low-density lipoprotein (LDL) cholesterol is a major modifiable risk factor for cardiovascular disease (CVD). While global trends in LDL-attributable CVD have been previously reported, disparities across sociodemographic development levels remain insufficiently explored.</div></div><div><h3>Objective</h3><div>To assess global, regional, and SDI-specific trends in the CVD burden attributable to high LDL cholesterol from 1990 to 2021.</div></div><div><h3>Methods</h3><div>We utilized Global Burden of Disease (GBD) 2021 data to evaluate CVD mortality and disability-adjusted life years (DALYs) attributable to high LDL cholesterol. Trends were assessed using annual percentage change (APC) in age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR), and age-standardized years lived with disability (ASYLD) by Socio-demographic Index (SDI), sex, and location.</div></div><div><h3>Results</h3><div>From 1990 to 2021, global ASMR and ASDR attributable to high LDL cholesterol declined. In 2021, ASMR and ASDR were lowest in high SDI regions. Israel recorded the largest decrease in APC for both ASMR and ASDR, while Lesotho exhibited the highest increase. Over the same period, Singapore showed the greatest decline in APC of ASYLD, whereas Tanzania had the most pronounced increase. The greatest reductions in APC of ASMR and ASDR from 1990 to 2021 were observed in high SDI countries, particularly during the decade 2000–2010. Females consistently showed declining APCs of ASMR across all SDI quintiles, whereas in males, APCs declined only in high and high-middle SDI countries.</div></div><div><h3>Conclusion</h3><div>Persistent disparities in CVD burden attributable to high LDL across SDI quintiles highlight the need for equitable, tailored lipid-lowering and cardiometabolic prevention strategies.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 18-19"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Both SGLT2 inhibitors and GLP-1 receptor agonists have demonstrated cardiovascular benefits in type 2 diabetes (T2D), but their comparative arrhythmogenic profiles in patients with comorbid inflammatory polyarthropathy remain unclear. This study aimed to evaluate the differential risk of cardiac arrhythmias between these two drug classes in this specific patient population.
Methods
In this retrospective cohort study using the TriNetX global federated health research network, we identified adult patients with T2D and inflammatory polyarthropathy who were initiated on either SGLT2 inhibitors (n=3,278) or GLP-1 receptor agonists (n=4,612). After propensity score matching (n=2,838 per group), we compared the incidence of various arrhythmias including atrial fibrillation, ventricular tachycardia, ventricular fibrillation, sick sinus syndrome, and need for pacemaker implantation over a 5-year follow-up period.
Results
Patients treated with SGLT2 inhibitors demonstrated significantly higher rates of atrial fibrillation (10.4% vs 7.8%, HR 1.552, 95% CI 1.303-1.848, p<0.001) and ventricular tachycardia (4.8% vs 2.2%, HR 2.467, 95% CI 1.825-3.334, p<0.001) compared to those receiving GLP-1 receptor agonists. Ventricular fibrillation was also more common in the SGLT2 inhibitor group (2.4% vs 0.8%, HR 3.451, 95% CI 2.131-5.590, p<0.001). Sick sinus syndrome occurred more frequently in SGLT2 inhibitor users (1.0% vs 0.7%), though this difference was not statistically significant. Pacemaker implantation rates were higher in the SGLT2 inhibitor cohort (5.1% vs 3.9%, HR 1.466, 95% CI 1.144-1.878, p=0.002).
Conclusion
Among patients with T2D and inflammatory polyarthropathy, treatment with GLP-1 receptor agonists was associated with significantly lower risk of major cardiac arrhythmias compared to SGLT2 inhibitors. These findings suggest that GLP-1 receptor agonists may represent a preferred option for patients with T2D and inflammatory arthritis who are at increased risk for cardiac arrhythmias. Further investigation is warranted to elucidate the mechanisms underlying these differences.
背景：SGLT2抑制剂和GLP-1受体激动剂均已证实对2型糖尿病（T2D）的心血管有益，但它们在合并炎性多关节病患者的心律失常发生率比较尚不清楚。本研究旨在评估这两种药物在这一特定患者群体中发生心律失常的风险差异。方法在这项使用TriNetX全球联合健康研究网络的回顾性队列研究中，我们确定了患有T2D和炎性多关节病的成年患者，他们开始使用SGLT2抑制剂（n=3,278）或GLP-1受体激动剂（n=4,612）。经过倾向评分匹配（每组2838例），我们比较了5年随访期间各种心律失常的发生率，包括房颤、室性心动过速、室颤、病态窦性综合征和起搏器植入需求。结果与接受GLP-1受体激动剂治疗的患者相比，接受SGLT2抑制剂治疗的患者房颤（10.4% vs 7.8%, HR 1.552, 95% CI 1.303-1.848, p<0.001）和室性心动过速（4.8% vs 2.2%, HR 2.467, 95% CI 1.825-3.334, p<0.001）的发生率显著高于接受GLP-1受体激动剂治疗的患者。心室颤动在SGLT2抑制剂组中也更为常见（2.4% vs 0.8%, HR 3.451, 95% CI 2.131-5.590, p<0.001）。SGLT2抑制剂使用者的窦病综合征发生率更高（1.0% vs 0.7%），但差异无统计学意义。SGLT2抑制剂组的起搏器植入率更高（5.1% vs 3.9%, HR 1.466, 95% CI 1.144-1.878, p=0.002）。结论在t2dm和炎性多关节病患者中，与SGLT2抑制剂相比，GLP-1受体激动剂治疗与重大心律失常的风险显著降低相关。这些发现表明，GLP-1受体激动剂可能是T2D和炎症性关节炎患者心律失常风险增加的首选。需要进一步的研究来阐明这些差异背后的机制。
{"title":"Comparative Analysis of Arrhythmia Risk: SGLT2 inhibitors versus GLP-1 Receptor Agonists in Patients with Type 2 Diabetes and Inflammatory Arthritis","authors":"Godbless Ajenaghughrure M.D. , Sila Mateo Faxas M.D. , Kim Nguyen M.D. , Gurjot Singh M.D. , Nirys Mateo Faxas M.D. , Dharana Gelal M.D. , Karldon Nwazeaupu M.D. , Nicole Tejeda Zoz M.D. , Kimberly Ramirez Bonetti M.D. , Erick Perez Mejias M.D.","doi":"10.1016/j.ahj.2025.07.021","DOIUrl":"10.1016/j.ahj.2025.07.021","url":null,"abstract":"<div><h3>Background</h3><div>Both SGLT2 inhibitors and GLP-1 receptor agonists have demonstrated cardiovascular benefits in type 2 diabetes (T2D), but their comparative arrhythmogenic profiles in patients with comorbid inflammatory polyarthropathy remain unclear. This study aimed to evaluate the differential risk of cardiac arrhythmias between these two drug classes in this specific patient population.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study using the TriNetX global federated health research network, we identified adult patients with T2D and inflammatory polyarthropathy who were initiated on either SGLT2 inhibitors (n=3,278) or GLP-1 receptor agonists (n=4,612). After propensity score matching (n=2,838 per group), we compared the incidence of various arrhythmias including atrial fibrillation, ventricular tachycardia, ventricular fibrillation, sick sinus syndrome, and need for pacemaker implantation over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>Patients treated with SGLT2 inhibitors demonstrated significantly higher rates of atrial fibrillation (10.4% vs 7.8%, HR 1.552, 95% CI 1.303-1.848, p<0.001) and ventricular tachycardia (4.8% vs 2.2%, HR 2.467, 95% CI 1.825-3.334, p<0.001) compared to those receiving GLP-1 receptor agonists. Ventricular fibrillation was also more common in the SGLT2 inhibitor group (2.4% vs 0.8%, HR 3.451, 95% CI 2.131-5.590, p<0.001). Sick sinus syndrome occurred more frequently in SGLT2 inhibitor users (1.0% vs 0.7%), though this difference was not statistically significant. Pacemaker implantation rates were higher in the SGLT2 inhibitor cohort (5.1% vs 3.9%, HR 1.466, 95% CI 1.144-1.878, p=0.002).</div></div><div><h3>Conclusion</h3><div>Among patients with T2D and inflammatory polyarthropathy, treatment with GLP-1 receptor agonists was associated with significantly lower risk of major cardiac arrhythmias compared to SGLT2 inhibitors. These findings suggest that GLP-1 receptor agonists may represent a preferred option for patients with T2D and inflammatory arthritis who are at increased risk for cardiac arrhythmias. Further investigation is warranted to elucidate the mechanisms underlying these differences.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 4"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The practical use of NT-proBNP in different clinical situations should be interpreted depending on the patient profile.
Objective
analysis of NT-proBNP in the intervals of parameters of phenotypes of preserved and moderately reduced LVEF in patients with coronary artery disease and type 2 diabetes mellitus.
Material and Methods
130 patients with coronary artery disease (ESC) and type 2 diabetes mellitus (WHO, 1999), age 63,9±8,8 years, duration of coronary artery disease and type 2 diabetes mellitus – 9,69±0,49 and 7,3±3,89 years, HF with moderately reduced (group A, n-60) and preserved LVEF (group B (1), n-70). According to the H2FPEF scale, patients in group B were divided into the probability of HF >50% (2) and <50% (3). Demographic, NP-proBNP, sodium, eGFR, lipid and carbohydrate profile, LVEDP indicators (E/A, E/e′, LP index, ILVMM) were analyzed. Basic therapy: antiplatelet agents, beta-blockers, RAAS blockers, statins, empagliflozin, i-DPP-4, metformin. Duration of observation is 2 years.
Results
The difference between groups A and B was shown in NP-proBNP (outcome): 1293,96±1658,80 vs. 396,21±477,97 pg /ml (t=36,979; p=0,000) and observation 1374,21±1967,36 vs. 362,86±624,96 (t=27,766; p=0,000), respectively. Comparison of group B with (2) and 3 subgroups did not register intergroup differences in NP-proBNP before and after 2 years of observation. During basic therapy, LVEF in the EF <50% group increased from 45,2 [43,2; 47,8] to 47,9% [45,2; 54,3] (t=15,892; p=0,000), and did not change in 2 and 3. Intergroup differences (2 and 3) were revealed in LA (t=2,905; p=0,088), LA volume (t=6,20; p=0,01), EDD (t=4,72; p=0,03) and ESD (t=7,36; p=0,007) before and (t=6,72; p=0.01) after (t=5,17; p=0,02), E/e` before (t=9,917; p=0,002) and after (t=3,996; p=0,046) 2 years of observation.
Conclusion
For patients with coronary artery disease and type 2 diabetes mellitus, it is important to evaluate E/e' screening to monitor the progression of LVEF; when empagliflozin is prescribed, LVEF indicators improve.
{"title":"Possibilities of Screening and Intervention Strategies in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus with the Risk of HF","authors":"R.Kh. Trigulova , A.A. Ikramov , D.T. Akhmedova , Sh.Sh. Mukhtarova , D.A. Alimova , Sh.S. Akhmedova","doi":"10.1016/j.ahj.2025.07.023","DOIUrl":"10.1016/j.ahj.2025.07.023","url":null,"abstract":"<div><h3>Introduction</h3><div>The practical use of NT-proBNP in different clinical situations should be interpreted depending on the patient profile.</div></div><div><h3>Objective</h3><div>analysis of NT-proBNP in the intervals of parameters of phenotypes of preserved and moderately reduced LVEF in patients with coronary artery disease and type 2 diabetes mellitus.</div></div><div><h3>Material and Methods</h3><div>130 patients with coronary artery disease (ESC) and type 2 diabetes mellitus (WHO, 1999), age 63,9±8,8 years, duration of coronary artery disease and type 2 diabetes mellitus – 9,69±0,49 and 7,3±3,89 years, HF with moderately reduced (group A, n-60) and preserved LVEF (group B (1), n-70). According to the H2FPEF scale, patients in group B were divided into the probability of HF >50% (2) and <50% (3). Demographic, NP-proBNP, sodium, eGFR, lipid and carbohydrate profile, LVEDP indicators (E/A, E/e′, LP index, ILVMM) were analyzed. Basic therapy: antiplatelet agents, beta-blockers, RAAS blockers, statins, empagliflozin, i-DPP-4, metformin. Duration of observation is 2 years.</div></div><div><h3>Results</h3><div>The difference between groups A and B was shown in NP-proBNP (outcome): 1293,96±1658,80 vs. 396,21±477,97 pg /ml (t=36,979; p=0,000) and observation 1374,21±1967,36 vs. 362,86±624,96 (t=27,766; p=0,000), respectively. Comparison of group B with (2) and 3 subgroups did not register intergroup differences in NP-proBNP before and after 2 years of observation. During basic therapy, LVEF in the EF <50% group increased from 45,2 [43,2; 47,8] to 47,9% [45,2; 54,3] (t=15,892; p=0,000), and did not change in 2 and 3. Intergroup differences (2 and 3) were revealed in LA (t=2,905; p=0,088), LA volume (t=6,20; p=0,01), EDD (t=4,72; p=0,03) and ESD (t=7,36; p=0,007) before and (t=6,72; p=0.01) after (t=5,17; p=0,02), E/e` before (t=9,917; p=0,002) and after (t=3,996; p=0,046) 2 years of observation.</div></div><div><h3>Conclusion</h3><div>For patients with coronary artery disease and type 2 diabetes mellitus, it is important to evaluate E/e' screening to monitor the progression of LVEF; when empagliflozin is prescribed, LVEF indicators improve.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 5"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.ahj.2025.07.063
Ekow Essien, Justice Owusu-Achiaw, Abraham Carboo, Karldon Nwaezeapu, Abena Agyekum, Patrick Berchie, Kwame Mensa-Yawson, Edmund Mireku Bediako
Background
Bariatric surgery provides significant benefits for patients with obesity, but cardiovascular outcomes might be further improved with adjunctive pharmacotherapy. This study aimed to evaluate the cardiovascular benefits of semaglutide as an adjunct to bariatric surgery compared to bariatric surgery alone.
Methods
Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of patients with obesity (BMI ≥30 kg/m²) who underwent bariatric surgery. The semaglutide cohort (n=37,026) included patients who received semaglutide after bariatric surgery, while the control cohort (n=273,513) included those who underwent bariatric surgery without semaglutide. After propensity score matching (n=36,744 per group), we analyzed cardiovascular outcomes over a 5-year follow-up period.
Results
Semaglutide use was associated with significantly lower all-cause mortality (1.0% vs 2.2%; HR 0.362, 95% CI 0.320-0.410; p<0.001) and cardiogenic shock (0.1% vs 0.2%; HR 0.470, 95% CI 0.330-0.671; p<0.001). Patients receiving semaglutide demonstrated lower incidence of pulmonary complications, including pulmonary edema (HR 0.595), pulmonary hypertension (HR 0.600), and pulmonary embolism (HR 0.709). Semaglutide was also associated with reduced risk of acute kidney injury (HR 0.742) and atrial fibrillation (HR 0.781).
Conclusion
In patients with obesity who underwent bariatric surgery, adjunctive semaglutide therapy was associated with significantly lower mortality and reduced incidence of major cardiovascular and renal complications. These findings suggest that combining semaglutide with bariatric surgery may provide additive cardiovascular protection.
背景：减肥手术为肥胖患者提供了显著的益处，但辅助药物治疗可能会进一步改善心血管预后。本研究旨在评估西马鲁肽作为辅助减肥手术与单独减肥手术相比对心血管的益处。方法使用TriNetX全球协作网络，我们对接受减肥手术的肥胖（BMI≥30 kg/m²）患者进行了回顾性队列研究。semaglutide队列（n=37,026）包括在减肥手术后接受semaglutide的患者，而对照队列（n=273,513）包括那些接受减肥手术而不使用semaglutide的患者。在倾向评分匹配后（每组n=36,744），我们分析了5年随访期间的心血管结局。结果semaglutide的使用显著降低了全因死亡率（1.0% vs 2.2%; HR 0.362, 95% CI 0.320-0.410; p<0.001）和心源性休克（0.1% vs 0.2%; HR 0.470, 95% CI 0.330-0.671; p<0.001）。接受西马鲁肽治疗的患者肺部并发症发生率较低，包括肺水肿（HR 0.595）、肺动脉高压（HR 0.600）和肺栓塞（HR 0.709）。Semaglutide还与降低急性肾损伤（HR 0.742）和房颤（HR 0.781）的风险相关。结论在接受减肥手术的肥胖患者中，辅助西马鲁肽治疗可显著降低死亡率，降低主要心血管和肾脏并发症的发生率。这些发现表明，西马鲁肽联合减肥手术可能提供额外的心血管保护。
{"title":"Comparative Cardiovascular Benefits of Semaglutide Adjunctive to Bariatric Surgery: A Real-World Analysis Using TriNetX","authors":"Ekow Essien, Justice Owusu-Achiaw, Abraham Carboo, Karldon Nwaezeapu, Abena Agyekum, Patrick Berchie, Kwame Mensa-Yawson, Edmund Mireku Bediako","doi":"10.1016/j.ahj.2025.07.063","DOIUrl":"10.1016/j.ahj.2025.07.063","url":null,"abstract":"<div><h3>Background</h3><div>Bariatric surgery provides significant benefits for patients with obesity, but cardiovascular outcomes might be further improved with adjunctive pharmacotherapy. This study aimed to evaluate the cardiovascular benefits of semaglutide as an adjunct to bariatric surgery compared to bariatric surgery alone.</div></div><div><h3>Methods</h3><div>Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of patients with obesity (BMI ≥30 kg/m²) who underwent bariatric surgery. The semaglutide cohort (n=37,026) included patients who received semaglutide after bariatric surgery, while the control cohort (n=273,513) included those who underwent bariatric surgery without semaglutide. After propensity score matching (n=36,744 per group), we analyzed cardiovascular outcomes over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>Semaglutide use was associated with significantly lower all-cause mortality (1.0% vs 2.2%; HR 0.362, 95% CI 0.320-0.410; p<0.001) and cardiogenic shock (0.1% vs 0.2%; HR 0.470, 95% CI 0.330-0.671; p<0.001). Patients receiving semaglutide demonstrated lower incidence of pulmonary complications, including pulmonary edema (HR 0.595), pulmonary hypertension (HR 0.600), and pulmonary embolism (HR 0.709). Semaglutide was also associated with reduced risk of acute kidney injury (HR 0.742) and atrial fibrillation (HR 0.781).</div></div><div><h3>Conclusion</h3><div>In patients with obesity who underwent bariatric surgery, adjunctive semaglutide therapy was associated with significantly lower mortality and reduced incidence of major cardiovascular and renal complications. These findings suggest that combining semaglutide with bariatric surgery may provide additive cardiovascular protection.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 28"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.ahj.2025.07.033
Seyed Arsalan Seyedi , Juan P. González-Rivas , Pranav Mellacheruvu , Ananya Mellacheruvu , Seyed Pedram Aledavood , Jeffrey I. Mechanick
Digital twin (DT) technology—real-time, data-driven virtual models of individuals—offers transformative potential in managing cardiometabolic-based chronic disease (CMBCD), a progressive continuum including abnormal adiposity (ABCD), hypertension (HBCD), dysglycemia (DBCD), dyslipidemia (LBCD), residual risk states, and cardiovascular diseases (CVDs). Type 2 diabetes (T2D), central in this cascade, requires individualized, integrative strategies where DT may serve as a precision-medicine tool. A systematic search across PubMed, Embase, Web of Science, Scopus, and Cochrane identified 12 eligible studies. Due to data duplication (five studies using the same cohort) and lack of homogeneity, meta-analysis was not feasible, prompting a narrative synthesis. DT-guided interventions were categorized across the CMBCD spectrum: (1) ABCD – DT reduced visceral fat and lowered BMI by 1.8 kg/m²; (2) DBCD – HbA1c dropped up to 1.8%, 89% achieved glycemic targets, fewer medications were used, time-in-range improved from 69.7% (±30.7) to 86.9% (±24.5), time-above-range decreased (p<0.001), and time-below-range slightly increased (p<0.001); (3) HBCD – normal blood pressure cases increased from 108 (46.4%) to 147 (63.1%), outperforming standard care, with 30 patients stopping antihypertensive drugs; (4) LBCD – triglycerides dropped 18.8% and HDL increased 6.8% (p<0.001); (5) Residual risk – DT improved liver fat/fibrosis (via imaging and fibrosis scores), and predicted CKD with area under the curves (AUCs) range from 0.80 to 0.86, retinopathy (AUC: 0.84), and cataracts (AUC: 0.93); (6) CVD outcomes – early trials show improved risk factors and medication de-escalation. DT appears promising for cardiometabolic risk management and personalized T2D care. Broader validation in diverse populations and refined implementation strategies are needed for clinical integration.
{"title":"Cardiometabolic Risk Reduction with Digital Twinning: A Narrative Review","authors":"Seyed Arsalan Seyedi , Juan P. González-Rivas , Pranav Mellacheruvu , Ananya Mellacheruvu , Seyed Pedram Aledavood , Jeffrey I. Mechanick","doi":"10.1016/j.ahj.2025.07.033","DOIUrl":"10.1016/j.ahj.2025.07.033","url":null,"abstract":"<div><div>Digital twin (DT) technology—real-time, data-driven virtual models of individuals—offers transformative potential in managing cardiometabolic-based chronic disease (CMBCD), a progressive continuum including abnormal adiposity (ABCD), hypertension (HBCD), dysglycemia (DBCD), dyslipidemia (LBCD), residual risk states, and cardiovascular diseases (CVDs). Type 2 diabetes (T2D), central in this cascade, requires individualized, integrative strategies where DT may serve as a precision-medicine tool. A systematic search across PubMed, Embase, Web of Science, Scopus, and Cochrane identified 12 eligible studies. Due to data duplication (five studies using the same cohort) and lack of homogeneity, meta-analysis was not feasible, prompting a narrative synthesis. DT-guided interventions were categorized across the CMBCD spectrum: (1) ABCD – DT reduced visceral fat and lowered BMI by 1.8 kg/m²; (2) DBCD – HbA1c dropped up to 1.8%, 89% achieved glycemic targets, fewer medications were used, time-in-range improved from 69.7% (±30.7) to 86.9% (±24.5), time-above-range decreased (p<0.001), and time-below-range slightly increased (p<0.001); (3) HBCD – normal blood pressure cases increased from 108 (46.4%) to 147 (63.1%), outperforming standard care, with 30 patients stopping antihypertensive drugs; (4) LBCD – triglycerides dropped 18.8% and HDL increased 6.8% (p<0.001); (5) Residual risk – DT improved liver fat/fibrosis (via imaging and fibrosis scores), and predicted CKD with area under the curves (AUCs) range from 0.80 to 0.86, retinopathy (AUC: 0.84), and cataracts (AUC: 0.93); (6) CVD outcomes – early trials show improved risk factors and medication de-escalation. DT appears promising for cardiometabolic risk management and personalized T2D care. Broader validation in diverse populations and refined implementation strategies are needed for clinical integration.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 10-11"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Premature menopause (PM) affects approximately 1% of women under 40 years of age and may increase cardiovascular risk but specific outcomes remain incompletely characterized. This study aimed to compare mortality and cardiovascular events between women with premature menopause and age-matched controls.
Methods
We performed a retrospective cohort study using the TriNetX Research Network (130 healthcare organizations). Women with PM (ICD-10 codes E28.31, E28.3, E28.319, E28.310) were compared to age-matched controls without PM. After propensity score matching for baseline demographics and comorbidities, cohorts of 9,245 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included heart failure (HF), arrhythmias, cerebrovascular disease (CVD), and other cardiovascular events. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a 10-year period.
Results
In propensity-matched cohorts, PM was associated with significantly higher all-cause mortality compared to controls (1.8% vs 0.6%; risk ratio [RR] 3.08, 95% CI 2.26-4.19; p<0.001). Women with PM had higher risks of CVD (RR 1.39, 95% CI 1.07-1.82; p=0.014), HF (RR 1.22, 95% CI 0.91-1.63; p=0.192), peripheral arterial disease (PAD; RR 1.43, 95% CI 1.06-1.95; p=0.019), and coronary artery disease (CAD; RR 1.54, 95% CI 1.01-2.34; p=0.044). No statistically significant differences were observed in atrial fibrillation or ventricular tachycardia rates.
Conclusion
PM is associated with significantly higher all-cause mortality and increased risk of CVD, HF, PAD and CAD. These findings highlight the importance of cardiovascular risk assessment and prevention in women with PM.
背景：40岁以下女性中约有1%的女性过早绝经，并可能增加心血管风险，但具体结果尚未完全确定。这项研究的目的是比较过早绝经妇女和同龄对照组的死亡率和心血管事件。方法采用TriNetX研究网络（130家医疗机构）进行回顾性队列研究。患有PM的女性（ICD-10代码E28.31, E28.3, E28.319, E28.310）与没有PM的年龄匹配的对照组进行比较。在基线人口统计学和合并症的倾向评分匹配后，分析了9245名患者的队列。主要结局为全因死亡率。次要结局包括心力衰竭（HF）、心律失常、脑血管疾病（CVD）和其他心血管事件。使用风险分析、Kaplan-Meier生存分析和10年期间的病例数分析来评估结果。结果在倾向匹配的队列中，与对照组相比，PM与更高的全因死亡率相关（1.8% vs 0.6%；风险比[RR] 3.08, 95% CI 2.26-4.19; p<0.001）。PM女性患心血管疾病（RR 1.39, 95% CI 1.07-1.82; p=0.014）、心绞痛（RR 1.22, 95% CI 0.91-1.63; p=0.192）、外周动脉疾病（PAD; RR 1.43, 95% CI 1.06-1.95; p=0.019）和冠状动脉疾病（CAD; RR 1.54, 95% CI 1.01-2.34; p=0.044）的风险较高。两组在房颤和室性心动过速方面无统计学差异。结论pm与CVD、HF、PAD和CAD的全因死亡率显著升高相关。这些发现强调了PM女性心血管风险评估和预防的重要性。
{"title":"Premature Menopause and Risk of Cardiovascular Outcomes: A Propensity-Matched Analysis Using the TriNetX Research Network","authors":"Abena Korwaa Agyekum MD , Ekow Essien MD , Karldon Nwaezeapu MD , Godbless Ajenaghughrure MD , Nana Osei MD , Esther Obeng-Danso MD , Awuradjoa Ayirebi-Acquah MD , Gloria Amoako MD , Suzette Graham-Hill MD","doi":"10.1016/j.ahj.2025.07.035","DOIUrl":"10.1016/j.ahj.2025.07.035","url":null,"abstract":"<div><h3>Background</h3><div>Premature menopause (PM) affects approximately 1% of women under 40 years of age and may increase cardiovascular risk but specific outcomes remain incompletely characterized. This study aimed to compare mortality and cardiovascular events between women with premature menopause and age-matched controls.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the TriNetX Research Network (130 healthcare organizations). Women with PM (ICD-10 codes E28.31, E28.3, E28.319, E28.310) were compared to age-matched controls without PM. After propensity score matching for baseline demographics and comorbidities, cohorts of 9,245 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included heart failure (HF), arrhythmias, cerebrovascular disease (CVD), and other cardiovascular events. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a 10-year period.</div></div><div><h3>Results</h3><div>In propensity-matched cohorts, PM was associated with significantly higher all-cause mortality compared to controls (1.8% vs 0.6%; risk ratio [RR] 3.08, 95% CI 2.26-4.19; p<0.001). Women with PM had higher risks of CVD (RR 1.39, 95% CI 1.07-1.82; p=0.014), HF (RR 1.22, 95% CI 0.91-1.63; p=0.192), peripheral arterial disease (PAD; RR 1.43, 95% CI 1.06-1.95; p=0.019), and coronary artery disease (CAD; RR 1.54, 95% CI 1.01-2.34; p=0.044). No statistically significant differences were observed in atrial fibrillation or ventricular tachycardia rates.</div></div><div><h3>Conclusion</h3><div>PM is associated with significantly higher all-cause mortality and increased risk of CVD, HF, PAD and CAD. These findings highlight the importance of cardiovascular risk assessment and prevention in women with PM.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 11-12"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Both tirzepatide (a dual GIP/GLP-1 receptor agonist) and liraglutide (a GLP-1 receptor agonist) have demonstrated cardiometabolic benefits, but their comparative cardiovascular outcomes in high-risk populations remain poorly characterized. This study compared mortality and cardiovascular outcomes between obese patients with sleep apnea treated with tirzepatide versus liraglutide.
Methods
We performed a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data across 128 healthcare organizations. Obese patients (BMI ≥30 kg/m²) with sleep apnea who were prescribed either tirzepatide or liraglutide were identified. After propensity score matching for demographics and comorbidities, cohorts of 21,356 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiac events, arrhythmias, and other clinical outcomes. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a five-year follow-up period.
Results
Tirzepatide use was associated with significantly lower all-cause mortality compared to liraglutide (0.7% vs 1.4%; risk ratio [RR] 0.479, 95% CI 0.394-0.582; p<0.001). Tirzepatide-treated patients also had reduced risks of heart failure (RR 0.658, 95% CI 0.583-0.743), atrial fibrillation (RR 0.706, 95% CI 0.605-0.823), ventricular tachycardia (RR 0.749, 95% CI 0.585-0.958), and cerebrovascular disease (RR 0.781, 95% CI 0.683-0.893). Additionally, tirzepatide was associated with lower risks of acute kidney injury, hypertension, coronary artery disease, and peripheral arterial disease (all p<0.05).
Conclusion
In obese patients with sleep apnea, tirzepatide was associated with significantly lower all-cause mortality and reduced cardiovascular events compared to liraglutide. These findings suggest potential cardiovascular advantages of dual GIP/GLP-1 receptor agonism over GLP-1 receptor agonism alone in this high-risk population.
研究背景：替西肽（一种双GIP/GLP-1受体激动剂）和利拉鲁肽（一种GLP-1受体激动剂）均已证实对心脏代谢有益，但在高危人群中，它们的心血管预后比较仍不清楚。这项研究比较了肥胖睡眠呼吸暂停患者使用替西帕肽和利拉鲁肽治疗的死亡率和心血管结局。方法我们使用TriNetX全球协作网络进行了一项回顾性队列研究，分析了128家医疗机构的数据。肥胖患者（BMI≥30 kg/m²）伴有睡眠呼吸暂停，使用替西帕肽或利拉鲁肽。在对人口统计学和合并症进行倾向评分匹配后，分析了21356名患者的队列。主要结局为全因死亡率。次要结局包括心脏事件、心律失常和其他临床结局。使用风险分析、Kaplan-Meier生存分析和5年随访期间的病例数分析来评估结果。结果与利拉鲁肽相比，使用舒帕肽的全因死亡率显著降低（0.7% vs 1.4%；风险比[RR] 0.479, 95% CI 0.394-0.582; p<0.001）。替西肽治疗的患者心衰（RR = 0.658, 95% CI = 0.583-0.743）、房颤（RR = 0.706, 95% CI = 0.605-0.823）、室性心动过速（RR = 0.749, 95% CI = 0.585-0.958）和脑血管疾病（RR = 0.781, 95% CI = 0.683-0.893）的风险也降低。此外，替西肽与较低的急性肾损伤、高血压、冠状动脉疾病和外周动脉疾病风险相关（p < 0.05）。结论在伴有睡眠呼吸暂停的肥胖患者中，与利拉鲁肽相比，替西帕肽能显著降低全因死亡率和心血管事件。这些发现表明，在高危人群中，双GIP/GLP-1受体激动剂比单独GLP-1受体激动剂有潜在的心血管优势。
{"title":"Comparative Cardiovascular Outcomes of Tirzepatide vs Liraglutide in Obese Patients with Sleep Apnea: A Propensity-Matched Analysis Using the TriNetX Research Network","authors":"Ekow Essien MD, Karldon Nwaezeapu MD, Abena Agyekum MD, Godbless Ajenaghughrure MD, Justice Owusu-Achiaw MD, Edmund Mireku Bediako MD","doi":"10.1016/j.ahj.2025.07.038","DOIUrl":"10.1016/j.ahj.2025.07.038","url":null,"abstract":"<div><h3>Background</h3><div>Both tirzepatide (a dual GIP/GLP-1 receptor agonist) and liraglutide (a GLP-1 receptor agonist) have demonstrated cardiometabolic benefits, but their comparative cardiovascular outcomes in high-risk populations remain poorly characterized. This study compared mortality and cardiovascular outcomes between obese patients with sleep apnea treated with tirzepatide versus liraglutide.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data across 128 healthcare organizations. Obese patients (BMI ≥30 kg/m²) with sleep apnea who were prescribed either tirzepatide or liraglutide were identified. After propensity score matching for demographics and comorbidities, cohorts of 21,356 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiac events, arrhythmias, and other clinical outcomes. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a five-year follow-up period.</div></div><div><h3>Results</h3><div>Tirzepatide use was associated with significantly lower all-cause mortality compared to liraglutide (0.7% vs 1.4%; risk ratio [RR] 0.479, 95% CI 0.394-0.582; p<0.001). Tirzepatide-treated patients also had reduced risks of heart failure (RR 0.658, 95% CI 0.583-0.743), atrial fibrillation (RR 0.706, 95% CI 0.605-0.823), ventricular tachycardia (RR 0.749, 95% CI 0.585-0.958), and cerebrovascular disease (RR 0.781, 95% CI 0.683-0.893). Additionally, tirzepatide was associated with lower risks of acute kidney injury, hypertension, coronary artery disease, and peripheral arterial disease (all p<0.05).</div></div><div><h3>Conclusion</h3><div>In obese patients with sleep apnea, tirzepatide was associated with significantly lower all-cause mortality and reduced cardiovascular events compared to liraglutide. These findings suggest potential cardiovascular advantages of dual GIP/GLP-1 receptor agonism over GLP-1 receptor agonism alone in this high-risk population.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 13-14"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Both psoriatic arthritis (PsA) and type 2 diabetes mellitus (T2DM) are associated with increased cardiovascular risk, but the impact of body mass index (BMI) on cardiac arrhythmias in this population remains unclear. This study examines the relationship between BMI status and risk of cardiac arrhythmias in patients with both PsA and T2DM.
Methods
Using the TriNetX global federated health research network accessing electronic medical records across 100 healthcare organizations, we conducted a retrospective cohort study. After propensity score matching, we compared two cohorts of patients with PsA and T2DM: non-obese (BMI <30 kg/m²; n=9,762) and obese (BMI 30-60 kg/m²; n=9,762). The primary outcomes were various cardiac arrhythmias, including atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, and sick sinus syndrome during a 5-year follow-up period.
Results
Non-obese patients with PsA and T2DM had significantly higher rates of atrial fibrillation (10.8% vs 9.7%, risk difference [RD]=1.1%, 95% CI 0.3-2.0%, p=0.009) compared to matched obese patients. The non-obese cohort also showed numerically higher rates of ventricular tachycardia (1.6% vs 1.3%, RD=0.3%, p=0.137), supraventricular tachycardia (1.8% vs 1.3%, RD=0.5%, p=0.001), and sick sinus syndrome (1.1% vs 0.9%, RD=0.2%, p=0.196). Kaplan-Meier analysis demonstrated significantly lower arrhythmia-free survival for non-obese patients (log-rank test p<0.05 for atrial fibrillation and supraventricular tachycardia). Additionally, non-obese patients had a 40.5% higher likelihood of requiring pacemaker implantation (hazard ratio 1.41, 95% CI 1.18-1.86).
Conclusions
Contrary to conventional wisdom, non-obese patients with concurrent PsA and T2DM demonstrated higher risk of cardiac arrhythmias compared to their obese counterparts. This suggests a potential protective effect of higher BMI in this specific patient population or reflects differences in underlying disease pathophysiology. Clinicians should consider more aggressive arrhythmia screening and monitoring in non-obese patients with PsA and T2DM, regardless of their apparently healthier weight profile.
背景银屑病关节炎（PsA）和2型糖尿病（T2DM）均与心血管风险增加相关，但在这一人群中，体重指数（BMI）对心律失常的影响尚不清楚。本研究探讨了PsA和T2DM患者的BMI状况与心律失常风险之间的关系。方法利用TriNetX全球联邦健康研究网络访问100家医疗机构的电子病历，我们进行了一项回顾性队列研究。在倾向评分匹配后，我们比较了两组PsA和T2DM患者：非肥胖（BMI <30 kg/m²；n= 9762）和肥胖（BMI 30-60 kg/m²；n= 9762）。在5年的随访期间，主要结局是各种心律失常，包括房颤、室性心动过速、室上性心动过速和病窦综合征。结果非肥胖合并PsA和T2DM患者的房颤发生率明显高于匹配的肥胖患者（10.8% vs 9.7%，风险差[RD]=1.1%, 95% CI 0.3-2.0%, p=0.009）。非肥胖组的室性心动过速（1.6% vs 1.3%， RD=0.3%, p=0.137）、室上性心动过速（1.8% vs 1.3%， RD=0.5%, p=0.001）和病态窦性综合征（1.1% vs 0.9%， RD=0.2%, p=0.196）的发生率也较高。Kaplan-Meier分析显示，非肥胖患者无心律失常生存率显著降低（log-rank检验心房颤动和室上性心动过速p<；0.05）。此外，非肥胖患者需要植入起搏器的可能性高出40.5%（风险比1.41,95% CI 1.18-1.86）。结论：与传统观点相反，患有PsA和T2DM的非肥胖患者比肥胖患者发生心律失常的风险更高。这表明高BMI在这一特定患者群体中具有潜在的保护作用，或者反映了潜在疾病病理生理学的差异。临床医生应该考虑对患有PsA和T2DM的非肥胖患者进行更积极的心律失常筛查和监测，无论他们的体重是否明显更健康。
{"title":"Arrhythmia Risk in Non-Obese versus Obese Patients with Psoriatic Arthritis and Type 2 Diabetes","authors":"Godbless Ajenaghughrure M.D. , Sila Mateo Faxas M.D. , Kim Nguyen M.D. , Gurjot Singh M.D. , Nirys Mateo Faxas M.D. , Dharana Gelal M.D. , Karldon Nwazeaupu M.D. , Nicole Tejeda Zoz M.D. , Kimberly Ramirez Bonetti M.D. , Erick Perez Mejias M.D.","doi":"10.1016/j.ahj.2025.07.025","DOIUrl":"10.1016/j.ahj.2025.07.025","url":null,"abstract":"<div><h3>Background</h3><div>Both psoriatic arthritis (PsA) and type 2 diabetes mellitus (T2DM) are associated with increased cardiovascular risk, but the impact of body mass index (BMI) on cardiac arrhythmias in this population remains unclear. This study examines the relationship between BMI status and risk of cardiac arrhythmias in patients with both PsA and T2DM.</div></div><div><h3>Methods</h3><div>Using the TriNetX global federated health research network accessing electronic medical records across 100 healthcare organizations, we conducted a retrospective cohort study. After propensity score matching, we compared two cohorts of patients with PsA and T2DM: non-obese (BMI <30 kg/m²; n=9,762) and obese (BMI 30-60 kg/m²; n=9,762). The primary outcomes were various cardiac arrhythmias, including atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, and sick sinus syndrome during a 5-year follow-up period.</div></div><div><h3>Results</h3><div>Non-obese patients with PsA and T2DM had significantly higher rates of atrial fibrillation (10.8% vs 9.7%, risk difference [RD]=1.1%, 95% CI 0.3-2.0%, p=0.009) compared to matched obese patients. The non-obese cohort also showed numerically higher rates of ventricular tachycardia (1.6% vs 1.3%, RD=0.3%, p=0.137), supraventricular tachycardia (1.8% vs 1.3%, RD=0.5%, p=0.001), and sick sinus syndrome (1.1% vs 0.9%, RD=0.2%, p=0.196). Kaplan-Meier analysis demonstrated significantly lower arrhythmia-free survival for non-obese patients (log-rank test p<0.05 for atrial fibrillation and supraventricular tachycardia). Additionally, non-obese patients had a 40.5% higher likelihood of requiring pacemaker implantation (hazard ratio 1.41, 95% CI 1.18-1.86).</div></div><div><h3>Conclusions</h3><div>Contrary to conventional wisdom, non-obese patients with concurrent PsA and T2DM demonstrated higher risk of cardiac arrhythmias compared to their obese counterparts. This suggests a potential protective effect of higher BMI in this specific patient population or reflects differences in underlying disease pathophysiology. Clinicians should consider more aggressive arrhythmia screening and monitoring in non-obese patients with PsA and T2DM, regardless of their apparently healthier weight profile.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 6"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-15DOI: 10.1016/j.ahj.2025.07.026
Masab A Mansoor DBA , Affan Rizwan MD
Background
Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Traditional risk prediction models often underperform in diabetic populations. This study aimed to develop and validate a machine learning (ML) model to predict CVD risk in T2DM patients using routinely collected clinical data with focus on parameter variability rather than absolute values.
Methods
We retrospectively analyzed data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative public dataset, selecting 5,426 T2DM patients without prior CVD (2015-2020). Multiple ML algorithms were trained to predict 3-year CVD risk. Input variables included demographic data, comorbidities, medications, and crucially, both median values and ranges (maximum minus minimum) of clinical parameters including HbA1c, creatinine, liver enzymes, and lipid profiles. Models were validated using 5-fold cross-validation.
Results
The random forest model demonstrated superior performance with an area under the receiver operating characteristic curve of 0.81 (95% CI: 0.79–0.83). Parameter variability provided stronger predictive value than median values for key variables. The top five predictors were creatinine variability, HbA1c variability, AST variability, ALP variability, and ALT variability, highlighting the importance of metabolic stability in CVD risk reduction.
Conclusion
This study demonstrates that fluctuations in routine clinical parameters, particularly renal and glycemic markers, outperform traditional static measurements in predicting CVD risk among T2DM patients. Implementation of this ML model could enhance clinical decision-making by identifying high-risk patients who might benefit from more intensive monitoring and earlier therapeutic interventions.
{"title":"Variability in Clinical Parameters as Predictors of Cardiovascular Disease in Type 2 Diabetes: A Machine Learning Approach","authors":"Masab A Mansoor DBA , Affan Rizwan MD","doi":"10.1016/j.ahj.2025.07.026","DOIUrl":"10.1016/j.ahj.2025.07.026","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Traditional risk prediction models often underperform in diabetic populations. This study aimed to develop and validate a machine learning (ML) model to predict CVD risk in T2DM patients using routinely collected clinical data with focus on parameter variability rather than absolute values.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative public dataset, selecting 5,426 T2DM patients without prior CVD (2015-2020). Multiple ML algorithms were trained to predict 3-year CVD risk. Input variables included demographic data, comorbidities, medications, and crucially, both median values and ranges (maximum minus minimum) of clinical parameters including HbA1c, creatinine, liver enzymes, and lipid profiles. Models were validated using 5-fold cross-validation.</div></div><div><h3>Results</h3><div>The random forest model demonstrated superior performance with an area under the receiver operating characteristic curve of 0.81 (95% CI: 0.79–0.83). Parameter variability provided stronger predictive value than median values for key variables. The top five predictors were creatinine variability, HbA1c variability, AST variability, ALP variability, and ALT variability, highlighting the importance of metabolic stability in CVD risk reduction.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that fluctuations in routine clinical parameters, particularly renal and glycemic markers, outperform traditional static measurements in predicting CVD risk among T2DM patients. Implementation of this ML model could enhance clinical decision-making by identifying high-risk patients who might benefit from more intensive monitoring and earlier therapeutic interventions.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 6-7"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown cardiovascular benefits in various populations, but their effects in hypertrophic cardiomyopathy (HCM) patients with type 2 diabetes remain understudied. This retrospective cohort study evaluated clinical outcomes in HCM patients with type 2 diabetes treated with SGLT2 inhibitors compared to those without SGLT2 therapy.
Methods
We utilized electronic medical records from the TriNetX Global Collaborative Network (136 healthcare organizations). Patients aged 18-79 with hypertrophic cardiomyopathy (ICD-10 codes I42.1, I42.2, or ICD-9 code 425.1) and type 2 diabetes mellitus were included. The SGLT2 inhibitor group (n=7,906) was compared with propensity-matched controls (n=7,906) who did not receive SGLT2 inhibitors. Outcomes were analyzed over a 5-year follow-up period.
Results
After propensity score matching, analysis revealed a significant reduction in all-cause mortality in the SGLT2 group compared to the control group (Risk Ratio 0.718, 95% CI 0.653-0.790, p<0.001). However, SGLT2 use was associated with significantly increased risk of cardiogenic shock (Risk Ratio 1.736, 95% CI 1.383-2.180, p<0.001). Smaller but statistically significant increases were observed in heart failure (p=0.001), syncope (p=0.013), ventricular tachycardia (p=0.002), atrial fibrillation (p=0.021), and acute kidney failure (p=0.003).
Conclusion
SGLT2 inhibitor use in HCM patients with type 2 diabetes was associated with significantly reduced all-cause mortality despite increased risk of cardiogenic shock and other cardiovascular complications. This may be due to the reduced pre-load caused by the diuretic effect of SGLT2 inhibitor. This complex cardiovascular risk profile warrants further investigation through prospective randomized controlled trials.
钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂在不同人群中显示出心血管益处，但其对肥厚性心肌病（HCM）合并2型糖尿病患者的影响仍未得到充分研究。这项回顾性队列研究评估了接受SGLT2抑制剂治疗的HCM合并2型糖尿病患者与未接受SGLT2治疗的患者的临床结果。方法利用TriNetX全球协同网络（136家医疗机构）的电子病历。患者年龄18-79岁，伴有肥厚性心肌病（ICD-10代码I42.1、I42.2或ICD-9代码425.1）和2型糖尿病。将SGLT2抑制剂组（n= 7906）与不接受SGLT2抑制剂的倾向匹配对照组（n= 7906）进行比较。结果分析了5年的随访期。结果倾向评分匹配后，分析显示，与对照组相比，SGLT2组的全因死亡率显著降低（风险比0.718,95% CI 0.653-0.790, p<0.001）。然而，SGLT2使用与心源性休克风险显著增加相关（风险比1.736,95% CI 1.383-2.180, p<0.001）。在心力衰竭（p=0.001）、晕厥（p=0.013）、室性心动过速（p=0.002）、心房颤动（p=0.021）和急性肾衰竭（p=0.003）中观察到较小但有统计学意义的增加。结论：在HCM合并2型糖尿病患者中使用sglt2抑制剂可显著降低全因死亡率，尽管心源性休克和其他心血管并发症的风险增加。这可能是由于SGLT2抑制剂的利尿作用减少了预负荷。这一复杂的心血管风险概况值得通过前瞻性随机对照试验进一步调查。
{"title":"SGLT2 Inhibitors in Patients with Hypertrophic Cardiomyopathy and Type 2 Diabetes: Mortality Benefit Despite Increased Cardiovascular Risk Profile","authors":"Karldon Iwuchukwu Nwaezeapu, Godbless Ajenaghughrure, Ekow Essien, Abena Agyekum","doi":"10.1016/j.ahj.2025.07.029","DOIUrl":"10.1016/j.ahj.2025.07.029","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown cardiovascular benefits in various populations, but their effects in hypertrophic cardiomyopathy (HCM) patients with type 2 diabetes remain understudied. This retrospective cohort study evaluated clinical outcomes in HCM patients with type 2 diabetes treated with SGLT2 inhibitors compared to those without SGLT2 therapy.</div></div><div><h3>Methods</h3><div>We utilized electronic medical records from the TriNetX Global Collaborative Network (136 healthcare organizations). Patients aged 18-79 with hypertrophic cardiomyopathy (ICD-10 codes I42.1, I42.2, or ICD-9 code 425.1) and type 2 diabetes mellitus were included. The SGLT2 inhibitor group (n=7,906) was compared with propensity-matched controls (n=7,906) who did not receive SGLT2 inhibitors. Outcomes were analyzed over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>After propensity score matching, analysis revealed a significant reduction in all-cause mortality in the SGLT2 group compared to the control group (Risk Ratio 0.718, 95% CI 0.653-0.790, p<0.001). However, SGLT2 use was associated with significantly increased risk of cardiogenic shock (Risk Ratio 1.736, 95% CI 1.383-2.180, p<0.001). Smaller but statistically significant increases were observed in heart failure (p=0.001), syncope (p=0.013), ventricular tachycardia (p=0.002), atrial fibrillation (p=0.021), and acute kidney failure (p=0.003).</div></div><div><h3>Conclusion</h3><div>SGLT2 inhibitor use in HCM patients with type 2 diabetes was associated with significantly reduced all-cause mortality despite increased risk of cardiogenic shock and other cardiovascular complications. This may be due to the reduced pre-load caused by the diuretic effect of SGLT2 inhibitor. This complex cardiovascular risk profile warrants further investigation through prospective randomized controlled trials.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 8-9"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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