Abstract
We acknowledge the comments made by Stefan et al. (1) and appreciate the opportunity to address them further while clarifying some points. The Penn Diabetes Heart Study (PDHS) is not a retrospective study but a prospective community-based cohort focusing on subclinical atherosclerosis in patients with type 2 diabetes. Notably, PDHS participants are recruited specifically to exclude clinical cardiovascular disease (CVD) or moderate-to-severe chronic kidney disease (CKD). However, the substantial burden of subclinical coronary atherosclerosis observed in PDHS participants (2) suggests an increased long-term cardiovascular risk. Therefore, the PDHS provides the opportunity to study subclinical peripheral atherosclerosis in patients with type 2 diabetes without the confounding and possible reverse causation associated with …
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