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Sodium-glucose cotransporter 2 inhibitors and cardiovascular events among patients with type 2 diabetes and low-to-normal body mass index: a nationwide cohort study. 钠-葡萄糖共转运体 2 抑制剂与 2 型糖尿病和低体重指数至正常体重指数患者的心血管事件:一项全国性队列研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-22 DOI: 10.1186/s12933-024-02478-7
Yuichiro Mori, Toshiaki Komura, Motohiko Adomi, Ryuichiro Yagi, Shingo Fukuma, Naoki Kondo, Motoko Yanagita, O Kenrik Duru, Katherine R Tuttle, Kosuke Inoue

Background: Patients with low-to-normal body mass index (BMI; < 25.0 kg/m2) were underrepresented in major randomized controlled trials on sodium-glucose cotransporter 2 (SGLT2) inhibitors for type 2 diabetes. The present study aims to investigate the effectiveness of SGLT2 inhibitors for cardiovascular outcomes among patients with type 2 diabetes and low-to-normal BMI, using finer stratification than previous trials.

Methods: This cohort study with a target trial emulation framework was conducted using insurance claims and health screening records of more than 30 million working-age citizens in Japan acquired from April 1, 2015 to March 31, 2022. 139,783 new users of SGLT2 inhibitors matched to 139,783 users of dipeptidyl protease (DPP) 4 inhibitors with stratification by BMI category (< 20.0, 20.0-22.4, 22.5-24.9, 25.0-29.9, 30.0-34.9, and 35.0 ≤ kg/m2). The primary outcome was a composite of all-cause death, myocardial infarction, stroke, or heart failure. Secondary outcomes were the components of the primary outcome. Cox proportional hazard models were used to compare SGLT2 inhibitors with DPP4 inhibitors in the whole population and subgroups defined by the BMI category.

Results: Among participants, 17.3% (n = 48,377) were female and 31.0% (n = 86,536) had low-to-normal BMI (< 20.0 kg/m2, 1.9% [n = 5,350]; 20.0-22.4 kg/m2, 8.5% [n = 23,818]; and 22.5-24.9 kg/m2, 20.5% [n = 57,368]). Over a median follow-up of 24 months, the primary outcome occurred in 2.9% (n = 8,165) of participants. SGLT2 inhibitors were associated with a decreased incidence of the primary outcome in the whole population (HR [95%CI] = 0.92 [0.89 to 0.96]), but not in patients with low-to-normal BMI (< 20.0 kg/m2, HR [95%CI] = 1.08 [0.80 to 1.46]; 20.0-22.4 kg/m2, HR [95%CI] = 1.04 [0.90 to 1.20]; and 22.5-24.9 kg/m2, HR [95%CI] = 0.92 [0.84 to 1.01]).

Conclusions: The protective effect of SGLT2 inhibitors on cardiovascular events among patients with type 2 diabetes appeared to decrease with lower BMI and was not significant among patients with low-to-normal BMI (< 25.0 kg/m2). These findings suggest the importance of considering BMI when initiating SGLT2 inhibitors.

背景:在有关钠-葡萄糖共转运体2(SGLT2)抑制剂治疗2型糖尿病的主要随机对照试验中,低体重指数至正常体重指数(BMI;2)患者的比例偏低。本研究旨在调查 SGLT2 抑制剂对 BMI 低至正常的 2 型糖尿病患者心血管预后的疗效,采用的分层方法比以往的试验更精细:这项采用目标试验仿真框架的队列研究使用了从 2015 年 4 月 1 日至 2022 年 3 月 31 日期间获得的 3000 多万日本劳动适龄公民的保险索赔和健康检查记录。139,783 名 SGLT2 抑制剂新用户与 139,783 名二肽基蛋白酶 (DPP) 4 抑制剂用户进行了匹配,并按体重指数类别进行了分层 (2)。主要结果是全因死亡、心肌梗死、中风或心力衰竭的复合结果。次要结果是主要结果的组成部分。采用 Cox 比例危险模型比较了 SGLT2 抑制剂和 DPP4 抑制剂在整个人群和按体重指数分类的亚组中的应用情况:在参与者中,17.3%(n = 48,377 人)为女性,31.0%(n = 86,536 人)为低至正常体重指数(2,1.9% [n = 5,350]; 20.0-22.4 kg/m2, 8.5% [n = 23,818]; and 22.5-24.9 kg/m2, 20.5% [n = 57,368] )。在中位随访 24 个月期间,2.9% 的参与者(n = 8,165 人)出现了主要结果。SGLT2抑制剂与整个人群中主要结局发生率的降低有关(HR [95%CI] = 0.92 [0.89 至 0.96]),但与低至正常体重指数患者中主要结局发生率的降低无关(2,HR [95%CI] = 1.08 [0.80 至 1.96])。08[0.80至1.46];20.0至22.4 kg/m2,HR [95%CI] = 1.04 [0.90至1.20];22.5至24.9 kg/m2,HR [95%CI] = 0.92 [0.84至1.01]):SGLT2抑制剂对2型糖尿病患者心血管事件的保护作用似乎随着体重指数的降低而减弱,在体重指数低至正常(< 25.0 kg/m2)的患者中并不显著。这些研究结果表明,在开始使用 SGLT2 抑制剂时考虑体重指数非常重要。
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引用次数: 0
Evaluation of the Steno Type 1 Risk Engine in predicting cardiovascular events in an ethnic mixed population of type 1 diabetes mellitus and its association with chronic microangiopathy complications. 评估 Steno 1 型风险引擎在 1 型糖尿病混血人群中预测心血管事件的能力及其与慢性微血管病变并发症的关联。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-22 DOI: 10.1186/s12933-024-02460-3
Isabella Cristina Paliares, Patrícia Medici Dualib, Laísa Stephane Noronha Torres, Priscila Maria Teixeira Aroucha, Bianca de Almeida-Pititto, Joao Roberto de Sa, Sérgio Atala Dib

Background: The Steno Type 1 Risk Engine (ST1RE) was developed to aid clinical decisions in primary prevention for individuals with type 1 diabetes (T1D), as existing cardiovascular (CV) risk models for the general population and type 2 diabetes tend to underestimate CV risk in T1D. However, the applicability of ST1RE in different populations remains uncertain, as prediction models developed for one population may not accurately estimate risk in another. This study aimed to evaluate the performance of the ST1RE in predicting CV events among ethnically mixed T1D individuals and its association with the progression of microangiopathy complications.

Methods: A retrospective survey of 435 adults with T1D who were free of CV events at baseline was assessed by ST1RE and chronic diabetes complications at 5 and 10 years of follow-up. The estimated CV risk rates were compared with the observed rates at 5 and 10 years using statistical analyses, including Receiver Operating Characteristic (ROC) curve analysis, Hosmer-Lemeshow test, Kaplan-Meier curves analysis and Cox-regression models.

Results: Among 435 patients (aged 25 years; interquartile range [IQR]: 21-32) with a median T1D duration of 13 years (IQR: 9-18), only 5% were categorized into the high ST1RE group. Within a median follow-up of 9.2 years (IQR 6.0-10.7), 5.5% of patients experienced a CV event (1.6%, 14.9%, and 50% from the low, moderate, and high-risk groups, respectively). The hazard ratios (HRs) for CV events were greater in the high-risk group (HR 52.02; 95% CI 18.60-145.51, p < 0.001) and in the moderate-risk group (HR 8.66; 95% CI 2.90-25.80, p < 0.001) compared to the low-risk group. The ST1RE estimated CV events were similar to the observed at 5 years (3.4% vs. 3.5%; χ2 = 10.12, p = 0.899) and 10 years (6.8% vs. 9.9%; χ2 = 14.80, p = 0.676) of follow-up. The progression of microangiopathies was greater in the high vs. low for retinopathy (p = 0.008), diabetic kidney disease (p < 0.001), peripheral neuropathy (p = 0.021), and autonomic neuropathy (p = 0.008).

Conclusions: ST1RE performed well in predicting CV events at 5 and 10 years of follow-up. Moreover, higher ST1RE scores were associated with the progression of microangiopathy complications in this genetically heterogeneous T1D population.

背景:现有的针对普通人群和 2 型糖尿病的心血管 (CV) 风险模型往往会低估 1 型糖尿病患者的 CV 风险,因此开发了 Steno 1 型糖尿病风险引擎 (ST1RE) 来帮助 1 型糖尿病 (T1D) 患者在一级预防方面做出临床决策。然而,ST1RE 在不同人群中的适用性仍不确定,因为针对某一人群开发的预测模型可能无法准确估计另一人群的风险。本研究旨在评估 ST1RE 在预测种族混杂的 T1D 患者的心血管事件方面的性能及其与微血管病变并发症进展的关系:对基线时未发生心血管事件的 435 名 T1D 成人进行回顾性调查,通过 ST1RE 和随访 5 年和 10 年的慢性糖尿病并发症进行评估。通过统计分析,包括接收者操作特征曲线(ROC)分析、Hosmer-Lemeshow 检验、Kaplan-Meier 曲线分析和 Cox 回归模型,将估计的 CV 风险率与 5 年和 10 年的观察率进行比较:在中位 T1D 病程为 13 年(IQR:9-18)的 435 名患者(年龄为 25 岁;四分位数间距 [IQR]:21-32)中,只有 5%的患者被归入高 ST1RE 组。在中位随访 9.2 年(IQR:6.0-10.7)期间,5.5% 的患者发生了 CV 事件(低、中、高风险组分别为 1.6%、14.9% 和 50%)。在高风险组(HR 52.02;95% CI 18.60-145.51,P 2 = 10.12,P = 0.899)和随访 10 年(6.8% 对 9.9%;χ2 = 14.80,P = 0.676)中,发生 CV 事件的危险比(HRs)更高。在视网膜病变(P = 0.008)、糖尿病肾病(P = 0.008)和糖尿病肾病(P = 0.008)方面,微血管病变的进展在高分辨率组与低分辨率组之间更大:ST1RE 在预测随访 5 年和 10 年的冠心病事件方面表现良好。此外,在这一基因异质性的 T1D 群体中,ST1RE 分数越高,微血管病变并发症的进展越快。
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引用次数: 0
Multi-modal characterisation of early-stage, subclinical cardiac deterioration in patients with type 2 diabetes. 2 型糖尿病患者早期亚临床心脏恶化的多模态特征。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-19 DOI: 10.1186/s12933-024-02465-y
Ambre Bertrand, Andrew Lewis, Julia Camps, Vicente Grau, Blanca Rodriguez

Background: Type 2 diabetes mellitus (T2DM) is a major risk factor for heart failure with preserved ejection fraction and cardiac arrhythmias. Precursors of these complications, such as diabetic cardiomyopathy, remain incompletely understood and underdiagnosed. Detection of early signs of cardiac deterioration in T2DM patients is critical for prevention. Our goal is to quantify T2DM-driven abnormalities in ECG and cardiac imaging biomarkers leading to cardiovascular disease.

Methods: We quantified ECG and cardiac magnetic resonance imaging biomarkers in two matched cohorts of 1781 UK Biobank participants, with and without T2DM, and no diagnosed cardiovascular disease at the time of assessment. We performed a pair-matched cross-sectional study to compare cardiac biomarkers in both cohorts, and examined the association between T2DM and these biomarkers. We built multivariate multiple linear regression models sequentially adjusted for socio-demographic, lifestyle, and clinical covariates.

Results: Participants with T2DM had a higher resting heart rate (66 vs. 61 beats per minute, p < 0.001), longer QTc interval (424 vs. 420ms, p < 0.001), reduced T wave amplitude (0.33 vs. 0.37mV, p < 0.001), lower stroke volume (72 vs. 78ml, p < 0.001) and thicker left ventricular wall (6.1 vs. 5.9mm, p < 0.001) despite a decreased Sokolow-Lyon index (19.1 vs. 20.2mm, p < 0.001). T2DM was independently associated with higher heart rate (beta = 3.11, 95% CI = [2.11,4.10], p < 0.001), lower stroke volume (beta = -4.11, 95% CI = [-6.03, -2.19], p < 0.001) and higher left ventricular wall thickness (beta = 0.133, 95% CI = [0.081,0.186], p < 0.001). Trends were consistent in subgroups of different sex, age and body mass index. Fewer significant differences were observed in participants of non-white ethnic background. QRS duration and Sokolow-Lyon index showed a positive association with the development of cardiovascular disease in cohorts with and without T2DM, respectively. A higher left ventricular mass and wall thickness were associated with cardiovascular outcomes in both groups.

Conclusion: T2DM prior to cardiovascular disease was linked with a higher heart rate, QTc prolongation, T wave amplitude reduction, as well as lower stroke volume and increased left ventricular wall thickness. Increased QRS duration and left ventricular wall thickness and mass were most strongly associated with future cardiovascular disease. Although subclinical, these changes may indicate the presence of autonomic dysfunction and diabetic cardiomyopathy.

背景:2 型糖尿病(T2DM)是导致射血分数保留型心力衰竭和心律失常的主要危险因素。这些并发症的前兆,如糖尿病心肌病,仍未得到充分认识和诊断。发现 T2DM 患者心脏恶化的早期迹象对于预防至关重要。我们的目标是量化 T2DM 导致心电图和心脏成像生物标志物异常,从而引发心血管疾病:方法:我们对两个匹配队列中的 1781 名英国生物数据库参与者的心电图和心脏磁共振成像生物标志物进行了量化,这两个队列分别有 T2DM 患者和无 T2DM 患者,在评估时均未确诊心血管疾病。我们进行了一项配对横断面研究,比较了两个队列中的心脏生物标志物,并研究了 T2DM 与这些生物标志物之间的关联。我们建立了多变量多元线性回归模型,依次调整了社会人口学、生活方式和临床协变量:结果:T2DM 患者的静息心率较高(66 对 61 次/分钟,P 结论:T2DM 患者的静息心率较低,而 T2DM 患者的静息心率较高:心血管疾病前的 T2DM 与较高的心率、QTc 延长、T 波振幅减小以及较低的搏出量和左心室壁厚度增加有关。QRS持续时间、左心室壁厚度和质量的增加与未来心血管疾病的关系最为密切。这些变化虽然是亚临床的,但可能表明存在自主神经功能障碍和糖尿病心肌病。
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引用次数: 0
Altered RBC deformability in diabetes: clinical characteristics and RBC pathophysiology. 糖尿病患者红细胞变形能力的改变:临床特征和红细胞病理生理学。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-18 DOI: 10.1186/s12933-024-02453-2
Ifechukwude Ebenuwa, Pierre-Christian Violet, Hongbin Tu, Casey Lee, Nicholas Munyan, Yu Wang, Mahtab Niyyati, Kartick Patra, Kenneth J Wilkins, Nermi Parrow, Mark Levine

Background: Reduced red blood cell deformability (RBCD) is associated with diabetic vascular complications, but early pathophysiological RBC changes and predictive demographic and clinical factors in populations with diabetes are unclear. An understanding of early diabetes-specific RBC changes associated with impaired RBCD is essential in investigating mechanisms that predispose to diabetic vascular complications.

Methods: We conducted an outpatient cross-sectional study of participants in a well-controlled diabetes cohort (N81) and nondiabetic controls (N78) at the National Institutes of Health. First, between-group differences in RBCD measures were assessed with shear stress-gradient ektacytometry. Differences in structural RBC parameters were assessed using osmotic gradient ektacytometry and NaCl osmotic fragility. Functional RBC changes were assessed using hemoglobin-oxygen dissociation: p50.

Results: All shear-stress gradient RBCD measures were significantly altered in the diabetes cohort vs. nondiabetic controls, even after adjustment for confounding covariates (p < 0.001). Adjusted for diabetes-status and demographic factors, significant predictors of reduced RBCD included older age, Black race, male gender, hyperglycemia, and vascular complications (all p < 0.05). Reduced RBCD was also associated with aberrant osmotic-gradient parameters, with a left-shift on osmotic gradient profile indicative of dehydrated RBCs in diabetes. A structure-function relationship was observed with reduced RBCD associated with reduced osmotic fragility (P < 0.001) and increased hemoglobin-oxygen dissociation (P < 0.01).

Conclusions: Findings suggest impaired RBCD incurs similar demographic and clinical risk factors as diabetic vascular disease, with early pathophysiological RBC changes indicative of disordered RBC hydration in diabetes. Findings provide strong evidence for disordered oxygen release as a functional consequence of reduced RBCD.

Clinical trial number: NCT00071526.

背景:红细胞变形性(RBCD)降低与糖尿病血管并发症有关,但早期病理生理RBC变化以及糖尿病患者的人口和临床预测因素尚不清楚。了解与 RBCD 受损相关的早期糖尿病特异性 RBC 变化对于研究糖尿病血管并发症的诱发机制至关重要:方法:我们在美国国立卫生研究院开展了一项门诊横断面研究,研究对象是控制良好的糖尿病队列中的参与者(81 人)和非糖尿病对照组(78 人)。首先,用剪切应力梯度电子血细胞计数法评估了RBCD测量的组间差异。利用渗透梯度检测法和氯化钠渗透脆性评估了RBC结构参数的差异。使用血红蛋白-氧解离度:p50评估RBC的功能性变化:结果:糖尿病组群与非糖尿病对照组相比,所有剪切应力梯度 RBCD 测量值都发生了显著变化,即使在调整了混杂的协变量后也是如此(p 结论:糖尿病组群与非糖尿病对照组相比,所有剪切应力梯度 RBCD 测量值都发生了显著变化,即使在调整了混杂的协变量后也是如此:研究结果表明,RBCD 受损会导致与糖尿病血管疾病相似的人口和临床风险因素,早期病理生理的 RBC 变化表明糖尿病患者的 RBC 水合失调。研究结果提供了强有力的证据,证明氧释放紊乱是 RBCD 减少的功能性后果:临床试验编号:NCT00071526。
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引用次数: 0
Non-alcoholic fatty liver disease risk with GLP-1 receptor agonists and SGLT-2 inhibitors in type 2 diabetes: a nationwide nested case-control study. 2 型糖尿病患者使用 GLP-1 受体激动剂和 SGLT-2 抑制剂的非酒精性脂肪肝风险:一项全国性巢式病例对照研究。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-17 DOI: 10.1186/s12933-024-02461-2
Kai-Cheng Chang, Fan-Chi Kuo, Chen-Yi Yang, Chun-Ting Yang, Huang-Tz Ou, Shihchen Kuo

Background: Non-alcoholic fatty liver diseases (NAFLDs)/non-alcoholic steatohepatitis (NASH) are the most common liver disorders among patients with type 2 diabetes. Newer classes of glucose-lowering agents (GLAs), such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is), have been shown to improve liver-related biomarkers. However, their effects on the development of NAFLD/NASH remain inconclusive.

Methods: A nested case-control study was conducted using Taiwan's National Health Insurance Research Database for 2011-2018. Patients aged ≥ 40 years, diagnosed with type 2 diabetes, having stable non-insulin GLA use, and without NAFLD/NASH history were included. Patients with incident NAFLD/NASH were matched up to 10 randomly sampled controls based on individual's age, gender, cohort entry date, type 2 diabetes diagnosis date, and disease risk score. Conditional logistic regression analyses were employed to estimate the association between liver risk and treatment exposure. Dose-response analysis was also performed.

Results: There were 621,438 study patients included for analysis. During 1.8 years of median follow-up, the incidence of NAFLD/NASH was 2.7 per 1000 person-years. After matching, 5,730 incident NAFLD cases (mean age: 57.6 years, male: 53.2%) and 45,070 controls (57.7 years, 52.7%) were identified. Using GLP-1RAs or SGLT2is was associated with an insignificantly lower NAFLD/NASH risk (i.e., odds ratios [95% CIs]: 0.84 [0.46-1.52] and 0.85 [0.63-1.14], respectively) and increased cumulative SGLT2i doses were significantly associated with a reduced NAFLD/NASH risk (0.61 [0.38-0.97]).

Conclusion: GLP-1RA and SGLT2i therapies in type 2 diabetes patients might prevent NAFLD/NASH development, with a significantly lower risk related to greater treatment exposure.

背景:非酒精性脂肪肝(NAFLD)/非酒精性脂肪性肝炎(NASH)是 2 型糖尿病患者最常见的肝脏疾病。胰高血糖素样肽-1受体激动剂(GLP-1RA)和钠-葡萄糖共转运体2抑制剂(SGLT2is)等新型降糖药物(GLA)已被证明可改善肝脏相关生物标志物。然而,这些药物对非酒精性脂肪肝/NASH的发病影响仍无定论:方法:利用2011-2018年台湾国民健康保险研究数据库开展了一项巢式病例对照研究。研究纳入了年龄≥ 40 岁、确诊为 2 型糖尿病、稳定使用非胰岛素 GLA 且无 NAFLD/NASH 病史的患者。根据患者的年龄、性别、队列加入日期、2型糖尿病诊断日期和疾病风险评分,将非酒精性脂肪肝/NASH患者与随机抽取的10名对照者进行配对。采用条件逻辑回归分析估计肝脏风险与治疗暴露之间的关系。此外,还进行了剂量反应分析:共有 621,438 名研究患者纳入分析。在 1.8 年的中位随访期间,非酒精性脂肪肝/NASH 的发病率为每 1000 人年 2.7 例。经过配对,确定了 5730 例非酒精性脂肪肝病例(平均年龄:57.6 岁,男性:53.2%)和 45070 例对照组病例(57.7 岁,52.7%)。使用 GLP-1RAs 或 SGLT2is 与非酒精性脂肪肝/NASH 风险的显著降低相关(即,几率比 [95% CIs]:0.84 [0.46-1.49] ):结论:GLP-1RA 和 SGLT2i 的累积剂量增加与非酒精性脂肪肝/NASH 风险降低显著相关(0.61 [0.38-0.97]):结论:2型糖尿病患者使用GLP-1RA和SGLT2i疗法可预防非酒精性脂肪肝/NASH的发生,治疗暴露越多,风险越低。
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引用次数: 0
Endothelial cells derived extracellular vesicles promote diabetic arterial calcification via circ_0008362/miR-1251-5p/Runx2 axial. 内皮细胞衍生的细胞外囊泡通过circ_0008362/miR-1251-5p/Runx2轴促进糖尿病动脉钙化
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-17 DOI: 10.1186/s12933-024-02440-7
Xiao Lin, Sha-Qi He, Su-Kang Shan, Feng Xu, Feng Wu, Fu-Xing-Zi Li, Ming-Hui Zheng, Li-Min Lei, Jia-Yue Duan, Yun-Yun Wu, Yan-Lin Wu, Ke-Xin Tang, Rong-Rong Cui, Bei Huang, Jun-Jie Yang, Xiao-Bo Liao, Jun Liu, Ling-Qing Yuan

Introduction: Arterial calcification, an independent predictor of cardiovascular events, increases morbidity and mortality in patients with diabetes mellitus (DM), but its mechanisms remain unclear. Extracellular vesicles (EVs) play an important role in intercellular communication. The study investigates the role and potential mechanisms of EVs derived from endothelial cells (ECs) in regulating vascular smooth muscle cell (VSMC) calcification under high glucose (HG) condition, with a goal of developing effective prevention and treatment strategies for diabetic arterial calcification.

Results: The results showed that EVs derived from HG induced ECs (ECHG-EVs) exhibited a bilayer structure morphology with a mean diameter of 74.08 ± 31.78 nm, expressing EVs markers including CD9, CD63 and TSG101, but not express calnexin. ECHG-EVs was internalized by VSMCs and induced VSMC calcification by increasing Runx2 expression and mineralized nodule formation. The circ_0008362 was enriched in ECHG-EVs, and it can be transmitted to VSMCs to promote VSMC calcification both in vitro and in vivo. Mechanistically, miR-1251-5p might be one of the targets of circ_0008362 and they were co-localization in the cytoplasm of VSMCs. Runx2 was identified as the downstream target of miR-1251-5p, and circ_0008362 acted as a sponge, enhancing Runx2 expression and then promoted VSMC calcification. Besides, circ_0008362 could directly interact with Runx2 to aggravate VSMC calcification. Notably, DiR-labelled ECHG-EVs was detected in the vessels of mice. Meanwhile, the level of circ_0008362 and Runx2 were increased significantly, while the expression of miR-1251-5p was decreased significantly in calcified artery tissues of mice. However, inhibiting the release of EVs by GW4869 attenuated arterial calcification in diabetic mice. Finally, the level of circulation of plasma EVs circ_0008362 was significantly higher in patients with DM compared with normal controls. Elevated levels of plasma EVs circ_0008362 were associated with more severe coronary and aorta artery calcification in patients with DM.

Conclusions: Our findings suggested that circ_0008362 was enriched in EVs derived from ECs and promoted VSMC calcification under HG conditions, both by sponging miR-1251-5p to upregulate Runx2 expression and through direct interaction with Runx2. Furthermore, elevated levels of plasma EVs circ_0008362 were associated with more severe coronary and aorta artery calcification in patients with DM. These results may serve as a potential prevention and therapeutic target for diabetic arterial calcification.

导言:动脉钙化是心血管事件的独立预测因素,会增加糖尿病(DM)患者的发病率和死亡率,但其机制仍不清楚。细胞外囊泡(EVs)在细胞间通信中发挥着重要作用。本研究探讨了内皮细胞(EC)衍生的EVs在高糖(HG)条件下调控血管平滑肌细胞(VSMC)钙化的作用和潜在机制,旨在为糖尿病动脉钙化制定有效的预防和治疗策略:结果表明,从HG诱导的ECs(ECHG-EVs)中提取的EVs呈双层结构形态,平均直径为74.08 ± 31.78 nm,表达CD9、CD63和TSG101等EVs标记物,但不表达钙粘蛋白。ECHG-EVs可被VSMC内化,并通过增加Runx2的表达和矿化结节的形成诱导VSMC钙化。circ_0008362在ECHG-EVs中富集,它可以传递给VSMCs,在体外和体内促进VSMC钙化。从机理上讲,miR-1251-5p可能是circ_0008362的靶标之一,而且它们在VSMCs的胞浆中共定位。Runx2被确定为miR-1251-5p的下游靶标,而circ_0008362则作为海绵,增强了Runx2的表达,进而促进了VSMC的钙化。此外,circ_0008362 还能直接与 Runx2 相互作用,加剧 VSMC 的钙化。值得注意的是,小鼠血管中检测到了 DiR 标记的 ECHG-EV。同时,在小鼠钙化的动脉组织中,circ_0008362 和 Runx2 的水平显著升高,而 miR-1251-5p 的表达则显著降低。然而,通过 GW4869 抑制 EVs 的释放可减轻糖尿病小鼠的动脉钙化。最后,与正常对照组相比,糖尿病患者血浆 EVs circ_0008362 的循环水平明显升高。血浆 EVs circ_0008362 水平的升高与糖尿病患者更严重的冠状动脉和主动脉钙化有关:我们的研究结果表明,circ_0008362富集于来源于EC的EVs中,并在HG条件下通过海绵状miR-1251-5p上调Runx2表达以及与Runx2直接相互作用促进VSMC钙化。此外,血浆中 EVs circ_0008362 水平的升高与糖尿病患者更严重的冠状动脉和主动脉钙化有关。这些结果可作为糖尿病动脉钙化的潜在预防和治疗靶点。
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引用次数: 0
Reduced circulating CD63+ extracellular vesicle levels associate with atherosclerosis in hypercholesterolaemic mice and humans. 循环 CD63+ 细胞外囊泡水平降低与高胆固醇血症小鼠和人类的动脉粥样硬化有关。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-17 DOI: 10.1186/s12933-024-02459-w
Brachyahu M Kestecher, Krisztina Németh, Sayam Ghosal, Nabil V Sayour, Tamás G Gergely, Bernadett R Bodnár, András I Försönits, Barbara W Sódar, Johannes Oesterreicher, Wolfgang Holnthoner, Zoltán V Varga, Zoltán Giricz, Péter Ferdinandy, Edit I Buzás, Xabier Osteikoetxea

Aims: The association and co-isolation of low-density lipoproteins (LDL) and extracellular vesicles (EVs) have been shown in blood plasma. Here we explore this relationship to better understand the role of EVs in atherogenesis.

Methods and results: Wild type (WT), PCSK9-/-, and LDLR-/- C57BL/6 mice were used in this study. Eleven week-old male mice were fed high-fat diet (HFD) for 12 weeks or kept on normal diet until old age (22-months). Cardiac function was assessed by ultrasound, cholesterol was quantified with a colorimetric kit and circulating EVs were measured using flow cytometry. Plaques were analysed post-mortem using Oil-Red-O staining of the aortic arch. EVs were measured from platelet free blood plasma samples of normal and hypercholesterolaemic clinical patients. Based on annexin V and CD63 staining, we found a significant increase in EV levels in LDLR-/- and PCSK9-/- mice after HFD, but CD81 showed no significant change in either group. There was no significant change in plaque formation after HFD. PCSK9-/- mice show a favourable cardiac function after HFD. Blood cholesterol levels progressively increased during HFD, with LDLR-/- mice showing high levels while PCSK9-/- were significantly lowered compared to WT animals. In mice at old age, similar cholesterol levels were observed as in young mice. In old age, LDLR-/- mice showed significantly increased plaques. At old age, ejection fraction was decreased in all groups of mice, as were CD63+ EVs. Similarly to mice, in patients with hypercholesterolaemia, CD63+ EVs were significantly depleted.

Conclusions: This research demonstrates an inverse relationship between circulating EVs and cholesterol, making EVs a potential marker for cardiovascular disease (CVD). HFD causes reduced cardiac function, but atherosclerotic development is slowly progressing in hypercholesterolaemic models and only observed with old animals. These results also bring further evidence for the benefit of using of PCSK9 inhibitors as therapeutic agents in CVD.

目的:血浆中存在低密度脂蛋白(LDL)和细胞外囊泡(EVs)的关联和共分离。在此,我们探讨了这种关系,以更好地了解 EVs 在动脉粥样硬化中的作用:本研究使用了野生型(WT)、PCSK9-/- 和 LDLR-/- C57BL/6 小鼠。11周大的雄性小鼠以高脂肪饮食(HFD)喂养12周,或以正常饮食喂养至老龄(22个月)。用超声波评估心脏功能,用比色试剂盒定量检测胆固醇,用流式细胞术测量循环EV。对主动脉弓的斑块进行死后油-红-O染色分析。从正常和高胆固醇血症临床患者的血小板游离血浆样本中测量 EVs。根据附件素 V 和 CD63 染色,我们发现 LDLR-/- 和 PCSK9-/- 小鼠在高脂血症后 EV 含量显著增加,但 CD81 在两组中均无显著变化。高频分解后,斑块的形成没有明显变化。PCSK9-/- 小鼠在高频分解后显示出良好的心脏功能。在高频分解过程中,血液胆固醇水平逐渐升高,与 WT 动物相比,LDLR-/- 小鼠的血液胆固醇水平较高,而 PCSK9-/- 小鼠的血液胆固醇水平则明显降低。老年小鼠的胆固醇水平与年轻小鼠相似。在老年期,LDLR-/-小鼠的斑块明显增加。在老年期,各组小鼠的射血分数均下降,CD63+ EVs 也下降。与小鼠类似,高胆固醇血症患者的 CD63+ EVs 也明显减少:这项研究表明,循环中的 EVs 与胆固醇之间存在反比关系,这使得 EVs 成为心血管疾病(CVD)的潜在标志物。高密度脂蛋白胆固醇血症会导致心脏功能减退,但动脉粥样硬化的发展在高胆固醇血症模型中进展缓慢,而且只有在老年动物身上才能观察到。这些结果还进一步证明了使用 PCSK9 抑制剂作为心血管疾病治疗药物的益处。
{"title":"Reduced circulating CD63<sup>+</sup> extracellular vesicle levels associate with atherosclerosis in hypercholesterolaemic mice and humans.","authors":"Brachyahu M Kestecher, Krisztina Németh, Sayam Ghosal, Nabil V Sayour, Tamás G Gergely, Bernadett R Bodnár, András I Försönits, Barbara W Sódar, Johannes Oesterreicher, Wolfgang Holnthoner, Zoltán V Varga, Zoltán Giricz, Péter Ferdinandy, Edit I Buzás, Xabier Osteikoetxea","doi":"10.1186/s12933-024-02459-w","DOIUrl":"https://doi.org/10.1186/s12933-024-02459-w","url":null,"abstract":"<p><strong>Aims: </strong>The association and co-isolation of low-density lipoproteins (LDL) and extracellular vesicles (EVs) have been shown in blood plasma. Here we explore this relationship to better understand the role of EVs in atherogenesis.</p><p><strong>Methods and results: </strong>Wild type (WT), PCSK9<sup>-/-</sup>, and LDLR<sup>-/-</sup> C57BL/6 mice were used in this study. Eleven week-old male mice were fed high-fat diet (HFD) for 12 weeks or kept on normal diet until old age (22-months). Cardiac function was assessed by ultrasound, cholesterol was quantified with a colorimetric kit and circulating EVs were measured using flow cytometry. Plaques were analysed post-mortem using Oil-Red-O staining of the aortic arch. EVs were measured from platelet free blood plasma samples of normal and hypercholesterolaemic clinical patients. Based on annexin V and CD63 staining, we found a significant increase in EV levels in LDLR<sup>-/-</sup> and PCSK9<sup>-/-</sup> mice after HFD, but CD81 showed no significant change in either group. There was no significant change in plaque formation after HFD. PCSK9<sup>-/-</sup> mice show a favourable cardiac function after HFD. Blood cholesterol levels progressively increased during HFD, with LDLR<sup>-/-</sup> mice showing high levels while PCSK9<sup>-/-</sup> were significantly lowered compared to WT animals. In mice at old age, similar cholesterol levels were observed as in young mice. In old age, LDLR<sup>-/-</sup> mice showed significantly increased plaques. At old age, ejection fraction was decreased in all groups of mice, as were CD63<sup>+</sup> EVs. Similarly to mice, in patients with hypercholesterolaemia, CD63<sup>+</sup> EVs were significantly depleted.</p><p><strong>Conclusions: </strong>This research demonstrates an inverse relationship between circulating EVs and cholesterol, making EVs a potential marker for cardiovascular disease (CVD). HFD causes reduced cardiac function, but atherosclerotic development is slowly progressing in hypercholesterolaemic models and only observed with old animals. These results also bring further evidence for the benefit of using of PCSK9 inhibitors as therapeutic agents in CVD.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"23 1","pages":"368"},"PeriodicalIF":8.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Transcriptome wide changes in long noncoding RNAs in diabetic ischemic heart disease. 糖尿病缺血性心脏病中长非编码 RNA 的转录组变化。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-17 DOI: 10.1186/s12933-024-02441-6
Amit Kumar Rai, Natarajaseenivasan Suriya Muthukumaran, Noemi Nisini, Tiffany Lee, Ioannis D Kyriazis, Claudio de Lucia, Michela Piedepalumbo, Rajika Roy, Shizuka Uchida, Konstantinos Drosatos, Malik Bisserier, Rajesh Katare, David Goukassian, Raj Kishore, Venkata Naga Srikanth Garikipati

More than 10% of adults in the United States have type 2 diabetes mellitus (DM) with a 2-4 times higher prevalence of ischemic heart disease than the non-diabetics. Despite extensive research approaches to limit this life-threatening condition have proven unsuccessful, highlighting the need for understanding underlying molecular mechanisms. Long noncoding RNAs (lncRNAs), which regulate gene expression by acting as signals, decoys, guides, or scaffolds have been implicated in diverse cardiovascular conditions. However, their role in ischemic heart disease in DM remains poorly understood. We provide new insights into the lncRNA expression profile after ischemic heart disease in DM mice. We performed unbiased RNA sequencing of well-characterized type 2 DM model db/db mice or its control db/+ subjected to sham or MI surgery. Computational analysis of the RNA sequencing of these LV tissues identified several differentially expressed lncRNAs between (db/db sham vs. db/db MI) including Gm19522 and Gm8075. lncRNA Gm-19522 may regulate DNA replication via DNA protein kinases, while lncRNA Gm-8075 is associated with cancer gene dysregulation and PI3K/Akt pathways. Thus, the downregulation of lncRNAs Gm19522 and Gm8075 post-MI may serve as potential biomarkers or novel therapeutic targets to improve cardiac repair/recovery in diabetic ischemic heart disease.

在美国,10% 以上的成年人患有 2 型糖尿病(DM),其缺血性心脏病的发病率是非糖尿病患者的 2-4 倍。尽管进行了广泛的研究,但限制这种威胁生命的疾病的方法都被证明是不成功的,这凸显了了解潜在分子机制的必要性。长非编码 RNA(lncRNA)通过充当信号、诱饵、向导或支架来调节基因表达,已被认为与多种心血管疾病有关。然而,人们对它们在糖尿病缺血性心脏病中的作用仍然知之甚少。我们对DM小鼠缺血性心脏病后的lncRNA表达谱有了新的认识。我们对特征明确的2型DM模型db/db小鼠或其对照组db/+进行了无偏见的RNA测序,这些小鼠均接受了假手术或心肌梗死手术。lncRNA Gm-19522可能通过DNA蛋白激酶调控DNA复制,而lncRNA Gm-8075则与癌基因失调和PI3K/Akt通路有关。因此,心肌梗死后lncRNA Gm19522和Gm8075的下调可作为潜在的生物标志物或新的治疗靶点,以改善糖尿病缺血性心脏病的心脏修复/恢复。
{"title":"Transcriptome wide changes in long noncoding RNAs in diabetic ischemic heart disease.","authors":"Amit Kumar Rai, Natarajaseenivasan Suriya Muthukumaran, Noemi Nisini, Tiffany Lee, Ioannis D Kyriazis, Claudio de Lucia, Michela Piedepalumbo, Rajika Roy, Shizuka Uchida, Konstantinos Drosatos, Malik Bisserier, Rajesh Katare, David Goukassian, Raj Kishore, Venkata Naga Srikanth Garikipati","doi":"10.1186/s12933-024-02441-6","DOIUrl":"https://doi.org/10.1186/s12933-024-02441-6","url":null,"abstract":"<p><p>More than 10% of adults in the United States have type 2 diabetes mellitus (DM) with a 2-4 times higher prevalence of ischemic heart disease than the non-diabetics. Despite extensive research approaches to limit this life-threatening condition have proven unsuccessful, highlighting the need for understanding underlying molecular mechanisms. Long noncoding RNAs (lncRNAs), which regulate gene expression by acting as signals, decoys, guides, or scaffolds have been implicated in diverse cardiovascular conditions. However, their role in ischemic heart disease in DM remains poorly understood. We provide new insights into the lncRNA expression profile after ischemic heart disease in DM mice. We performed unbiased RNA sequencing of well-characterized type 2 DM model db/db mice or its control db/+ subjected to sham or MI surgery. Computational analysis of the RNA sequencing of these LV tissues identified several differentially expressed lncRNAs between (db/db sham vs. db/db MI) including Gm19522 and Gm8075. lncRNA Gm-19522 may regulate DNA replication via DNA protein kinases, while lncRNA Gm-8075 is associated with cancer gene dysregulation and PI3K/Akt pathways. Thus, the downregulation of lncRNAs Gm19522 and Gm8075 post-MI may serve as potential biomarkers or novel therapeutic targets to improve cardiac repair/recovery in diabetic ischemic heart disease.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"23 1","pages":"365"},"PeriodicalIF":8.5,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unseen threat: how subclinical atherosclerosis increases mortality risk in patients with type 1 diabetes. 看不见的威胁:亚临床动脉粥样硬化如何增加 1 型糖尿病患者的死亡风险。
IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-17 DOI: 10.1186/s12933-024-02455-0
Lidia Sojo-Vega, Mònica Recasens, Joan Martínez, Alexandre Aguilera, Maria Ayala, Natàlia Admetlla, Paula Pellicer, Cristina Blay, Berta Fabregat, Mariona Esteve-Serra, Lídia Riera, Rebeca Barahona, Gemma Xifra, Eduardo Esteve, Josefina Biarnés, David Pérez, Gemma Gifre, Sílvia Mauri, Elisabet Costa, Marzena Wos, Maria Buxó, Mercè Fernández-Balsells

Background: Cardiovascular disease (CVD), particularly ischemic heart disease, remains the leading cause of death and morbidity in patients with type 1 diabetes. Detecting subclinical atherosclerosis could enhance cardiovascular risk stratification and enable individualised therapies. The aim of this study is to investigate the prevalence and predictors of subclinical atherosclerosis in patients with type 1 diabetes without overt cardiovascular disease (CVD) and to assess its impact on patient survival over a follow-up period of at least 5 years.

Methods: This observational study included 507 patients treated at the Diabetes Unit of the Hospital of Girona Doctor Josep Trueta between 2015 and 2023. The inclusion criteria for patients were as follows: those aged 18 and older with diabetes for a minimum of 10 years or those aged 40 and older with a diabetes for at least 5 years. Subclinical atherosclerosis was identified via ultrasound imaging of the carotid and femoral arteries. Clinical and biochemical evaluations were also conducted. Major cardiovascular events (MACE) and deaths from other causes were monitored, and survival analysis was performed using Kaplan‒Meier methods.

Results: Subclinical atherosclerosis was detected in 218 patients (43%). Multivariate analysis revealed that the male sex, diabetic nephropathy, tobacco exposure, higher HbA1c levels, older age, and longer diabetes duration were significant predictors. During a mean follow-up of 70.64 ± 27.08 months, 19 patients experienced MACE, and 13 died from any cause. The probability of MACE or death was greater in patients with subclinical atherosclerosis, with a hazard ratio (HR) of 25.1 (95% CI 5.81-108, p < 0.001) for MACE and an odds ratio (OR) of 7.57 (95% CI 1.97-53.9, p = 0.004) for death.

Conclusion: Subclinical atherosclerosis is independently associated with increased overall mortality and MACE in patients with type 1 diabetes. Identifying clinical predictors can improve risk stratification and personalised therapeutic strategies to prevent MACEs in this high-risk population.

背景:心血管疾病(CVD),尤其是缺血性心脏病,仍然是导致 1 型糖尿病患者死亡和发病的主要原因。检测亚临床动脉粥样硬化可加强心血管风险分层并实现个体化治疗。这项研究的目的是调查没有明显心血管疾病(CVD)的1型糖尿病患者亚临床动脉粥样硬化的患病率和预测因素,并评估亚临床动脉粥样硬化对随访至少5年的患者存活率的影响:这项观察性研究纳入了2015年至2023年期间在赫罗纳医生何塞普-特鲁埃塔医院糖尿病科接受治疗的507名患者。患者的纳入标准如下:年龄在18岁及以上、患有糖尿病至少10年的患者,或年龄在40岁及以上、患有糖尿病至少5年的患者。通过颈动脉和股动脉的超声波成像确定亚临床动脉粥样硬化。此外,还进行了临床和生化评估。对重大心血管事件(MACE)和其他原因导致的死亡进行了监测,并采用卡普兰-梅耶法进行了生存分析:结果:在218名患者(43%)中发现了亚临床动脉粥样硬化。多变量分析显示,男性、糖尿病肾病、烟草接触、较高的 HbA1c 水平、年龄和较长的糖尿病病程是重要的预测因素。在平均 70.64 ± 27.08 个月的随访期间,19 名患者发生了 MACE,13 名患者死于各种原因。亚临床动脉粥样硬化患者发生 MACE 或死亡的概率更高,危险比 (HR) 为 25.1(95% CI 5.81-108,P 结论:亚临床动脉粥样硬化患者发生 MACE 或死亡的概率更高,危险比 (HR) 为 25.1(95% CI 5.81-108,P 结论:亚临床动脉粥样硬化患者发生 MACE 或死亡的概率更高:亚临床动脉粥样硬化与 1 型糖尿病患者总死亡率和 MACE 的增加密切相关。确定临床预测因素可以改善风险分层和个性化治疗策略,从而预防这一高风险人群的并发症。
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引用次数: 0
Trajectories of triglyceride-glucose index changes and their association with all-cause and cardiovascular mortality: a competing risk analysis. 甘油三酯-葡萄糖指数变化轨迹及其与全因死亡率和心血管死亡率的关系:竞争风险分析。
IF 5.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-15 DOI: 10.1186/s12933-024-02457-y
Jun-Hyuk Lee, Soyoung Jeon, Hye Sun Lee, Ji-Won Lee

Background: The association between changes in insulin resistance, reflected by the triglyceride-glucose (TyG) index, and mortality remains unclear. This study investigated whether longitudinal trajectories of TyG index changes are associated with all-cause and cardiovascular disease (CVD) mortality.

Methods: This retrospective cohort study analyzed data from 233,546 adults aged ≥ 19 years from the Korea National Health Insurance Service-National Sample Cohort. Participants were categorized as having increasing, stable, or decreasing TyG index changes during a 4-year exposure period (2009-2014). Mortality outcomes were assessed during an 8.13-year follow-up period (2015-2021). Cox proportional hazards regression and competing risk analysis were used to evaluate all-cause and CVD mortality.

Results: A total of 7918 mortality events, including 651 CVD deaths, were recorded. Compared with the stable group, adjusted hazard ratios for all-cause mortality were 1.09 (95% CI 1.03-1.15) in the increasing group and 1.23 (95% CI 1.01-1.50) for CVD mortality. An increased TyG index was significantly associated with all-cause mortality in individuals aged < 50 years; men; and individuals with obesity, hypertension, diabetes, and/or dyslipidemia. For CVD mortality, significant associations were found in individuals aged 50-69 years, with obesity, with diabetes, or without dyslipidemia.

Conclusion: An increasing TyG index from baseline during follow-up was independently associated with higher risks of all-cause and CVD mortality. Serial monitoring of TyG index changes could enhance risk stratification and inform targeted interventions to reduce insulin resistance, and ultimately lower mortality risk.

背景:由甘油三酯-葡萄糖(TyG)指数反映的胰岛素抵抗的变化与死亡率之间的关系仍不清楚。本研究调查了TyG指数的纵向变化轨迹是否与全因死亡率和心血管疾病(CVD)死亡率有关:这项回顾性队列研究分析了韩国国民健康保险服务-全国抽样队列中 233,546 名年龄≥ 19 岁的成年人的数据。在 4 年的暴露期(2009-2014 年)内,参与者的 TyG 指数变化被分为上升、稳定或下降。在 8.13 年的随访期内(2015-2021 年),对死亡率结果进行了评估。采用 Cox 比例危险回归和竞争风险分析来评估全因死亡率和心血管疾病死亡率:共记录了 7918 例死亡事件,包括 651 例心血管疾病死亡。与稳定组相比,增加组的全因死亡率调整危险比为1.09(95% CI 1.03-1.15),心血管疾病死亡率调整危险比为1.23(95% CI 1.01-1.50)。TyG指数升高与结论年龄组的全因死亡率明显相关:在随访期间,TyG指数从基线开始上升与较高的全因和心血管疾病死亡风险独立相关。对TyG指数变化的连续监测可加强风险分层,并为有针对性的干预措施提供信息,以减少胰岛素抵抗,最终降低死亡风险。
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Cardiovascular Diabetology
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