Stroke risk in diabetic patients with concomitant cardiovascular disease the CARDIAB-Stroke study.

The long-term prognostic value of triglyceride-glucose index in type 2 diabetics without clinical coronary artery disease.

BACKGROUND The triglyceride-glucose (TyG) index, a simple laboratory marker of insulin resistance, has been associated with cardiometabolic risk. OBJECTIVES The purpose of this study was to evaluate whether baseline TyG predicts long-term major adverse cardiovascular events (MACE) in patients with type 2 diabetes (T2DM) without clinical coronary artery disease (CAD), independent of traditional risk factors and coronary artery calcium scoring (CACS). METHODS We conducted a retrospective analysis of a prospectively recruited cohort of 735 patients with T2DM, aged 55-74 years (48% women), enrolled between 2006 and 2008. All participants had at least one additional cardiovascular risk factor, no history or symptoms of CAD, and underwent computed tomography for CACS assessment. Multivariate Cox proportional hazards models were used to investigate the association of baseline TyG with the occurrence of myocardial infarction, stroke, or all-cause death, adjusting for demographic factors, diabetes severity, and CACS. RESULTS Over a median follow-up of 16.4 years, 327 patients experienced a first MACE. Compared with patients with TyG <50th percentile (<9.26), multivariable-adjusted hazard ratios (95% CI) were 1.62 (1.30-2.03), 1.84 (1.43-2.38), and 2.09 (1.48-2.94) for TyG ≥50th (≥9.26), >75th (>9.68), and ≥90th (>10.16) percentiles, respectively. The association remained significant after additional adjustment for diabetes severity and CACS. In a combined TyG-CACS model, MACE incidence progressively increased from 1.29 (TyG <9.26; CACS=0) to 5.33 (TyG >9.68; CACS ≥100) events per 100 patient-years. CONCLUSIONS In a cohort without known CAD, baseline TyG independently predicts long-term MACE in T2DM. This simple, widely available metabolic marker may enhance cardiovascular risk stratification and MACE primary prevention strategies.

Sepsis risk in patients with COPD and type 2 diabetes mellitus: influence of emerging antihyperglycemic therapies.

BACKGROUND AND OBJECTIVE Patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM) are at increased risk of sepsis, yet the comparative infection-related outcomes of newer antihyperglycemic agents remain unclear. We evaluated the associations of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus sodium-glucose cotransporter 2 inhibitors (SGLT2is) with infection outcomes in this population. METHODS In this retrospective cohort study using the TriNetX global federated database, individuals aged 40-100 years with coexisting COPD and T2DM who initiated a GLP-1RA or SGLT2i between 2021 and 2024 were identified. A new-user, active-comparator design with 1:1 propensity score matching was applied. Sepsis was the primary outcome; all-cause mortality and components of the primary outcome were secondary. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS After matching, 45,491 pairs were included. Compared with SGLT2is, GLP-1RAs showed lower risks of sepsis (adjusted HR, 0.832; 95% CI, 0.781-0.887), all-cause mortality (0.642; 0.598-0.689), and severe sepsis (0.841; 0.774-0.914). CONCLUSION In patients with COPD and T2DM, GLP-1RAs were associated with significantly lower risks of sepsis and all-cause mortality compared with SGLT2is.

Combination Pharmacotherapy in Type 2 Diabetes and Chronic Kidney Disease: Translating Evidence into Clinical Practice.

Joint Control of Inflammation, Cholesterol, and Lipoprotein(a) With Incident Cardiovascular Events in People With Type 2 Diabetes

We aimed to investigate the joint associations of high-sensitivity C-reactive protein (hsCRP), LDL cholesterol (LDL-C), and lipoprotein(a) [Lp(a)] with cardiovascular disease (CVD) among patients with type 2 diabetes. This prospective cohort study identified patients with type 2 diabetes from the UK Biobank. Baseline hsCRP, LDL-C, and Lp(a) were dichotomized according to guideline-recommended target levels. Patients were followed for incident atherosclerotic cardiovascular disease (ASCVD), total CVD (ASCVD plus heart failure), death, or study end. Competing risk models adjusted for important covariates were used. There were 29,658 patients with type 2 diabetes who were followed for a median of 15 years. Those with all three biomarkers above target had significantly increased risks compared with those with all at target: fatal and nonfatal ASCVD (adjusted hazard ratio 1.59; 95% CI 1.24, 2.03) and total CVD (adjusted hazard ratio 1.44; 95% CI 1.13, 1.83). Cardiovascular risk increased progressively as fewer biomarkers achieved target levels (all Ptrend < 0.001), with stronger associations in patients with shorter diabetes duration (<2 years vs. ≥2 years). Elevated hsCRP, LDL-C, and Lp(a) showed dose-dependent associations with cardiovascular risk in patients with type 2 diabetes, supporting their control in cardiovascular risk prevention.

Efficacy and safety of SGLT2 inhibitors in elderly patients with type 2 diabetes

Abstract Objectives To evaluate the effectiveness and safety of sodium-glucose co-transporter 2 (SGLT2) inhibitors in elderly patients with type 2 diabetes mellitus, with particular focus on renal and cardiovascular outcomes. Methods This retrospective cohort study analyzed data from 9,915 diabetic patients aged ≥65 years who received antihyperglycemic therapy at Changhua Christian Hospital, Taiwan, between January 2021 and September 2023. Patients were categorized as SGLT2 inhibitor users (n = 3,345) or non-users (n = 6,570). After 1:1 propensity score matching, 1,529 patients remained in each group. Primary outcomes included renal function (measured by eGFR decline), coronary artery disease, ischemic stroke, and heart failure. Secondary outcomes included urinary tract infection, genital infection, diabetic ketoacidosis, and hypoglycemia. Results SGLT2 inhibitor use was associated with significant renoprotective effects, demonstrated by reduced risk of 30% eGFR decline (HR 0.69, 95% CI 0.59–0.80, p < 0.001) and 50% eGFR decline (HR 0.60, 95% CI 0.45–0.80, p < 0.001). Subgroup analyses revealed that renoprotective effects were more pronounced in patients with higher baseline eGFR (≥50 mL/min/1.73 m2), suggesting greater benefit with early initiation of SGLT2 inhibitors for kidney protection. However, SGLT2 inhibitor use was associated with an increased risk of genital infections (HR 4.29, 95% CI 1.02–18.04, p = 0.047) in patients without prior history of such infections. Conclusions In elderly patients with type 2 diabetes, SGLT2 inhibitors demonstrate significant renal protective effects, particularly among those with preserved renal function (eGFR ≥50 mL/min/1.73 m2). These findings highlight the importance of considering patient characteristics when evaluating potential benefits of SGLT2 inhibitor therapy. The differential risk patterns suggest that clinicians should consider individual patient profiles and medical histories when prescribing these medications. The occurrence of major adverse cardiovascular events (MACE) did not exhibit a statistically significant difference between the cohort administered SGLT2 inhibitors and the cohort not receiving SGLT2 inhibitors (log-rank p-value = 0.160). Conversely, the recurrence of MACE was markedly reduced in the cohort receiving SGLT2 inhibitors (log-rank p-value < 0.001). These findings should be interpreted in the context of a single-center retrospective design and the inherent limitations of propensity-score-matched observational analyses.

Cardiovascular-Kidney-Metabolic Syndrome and Long-Term Risk of Cardiovascular Disease and all-cause Mortality.

AIMS To examine the associations between cardiovascular-kidney-metabolic syndrome (CKM) stages and the risk of cardiovascular disease (CVD), including atherosclerotic CVD (ASCVD), and all-cause mortality (ACM), stratified by sex. METHODS AND RESULTS Using a population-based cohort, CoLaus|PsyCoLaus, we categorized participants into CKM stages: 0 (no CKM factors), 1 (excess/dysfunctional adiposity), 2 (metabolic risk factors and/moderate- to high-risk CKD), 3 (very high predicted CVD risk per SCORE2/very high-risk CKD), and 4 (clinical CVD). Associations were assessed using generalized ordered logistic regression, Cox proportional hazards models, and population attributable fractions (PAFs). Among 5,752 participants (53.2% women; mean age: women 53.1 ± 10.7, men 52.3 ± 10.7 years), 580 CVD events (381 ASCVD), and 723 deaths occurred over 14.3 years. CKM stage distribution differed by sex (men vs women): 0 (9.9 vs 26.1%), 1 (13.3 vs 13.7%), 2 (62.6 vs 56.8%), 3 (9.4 vs 1.7%), 4 (4.8 vs 1.7%). Risk of CVD and ASCVD rose with higher CKM stage (vs stage 0), with HRs of 5.16 (95% CI, 2.61-10.19) and 3.82 (1.76-8.27) for stage 3 in men, compared with 1.92 (0.91-4.04) and 1.95 (0.79-4.81) in women. For all-cause mortality, risk peaked at stage 3 in women (3.43 [1.92-6.10]) and at stage 4 in men (2.42 [1.27-4.64]). Incremental PAFs peaked at stage 2. CONCLUSION CKM stages were associated with a stepwise increase in risk of CVD and all-cause mortality, with important sex-specific differences observed particularly for all-cause mortality. These findings support the relevance of CKM staging for cardiovascular risk stratification and prevention in the general population.