Five lipid-inflammation composite indices and obesity-related metabolic disorders, cardiovascular and renal diseases A multi-state trajectory analysis using data from the UK Biobank cohort.

Background: The usage of electronic device has two-sided effects on the health of middle-aged and elderly people. Its protective effects on cardiovascular disease (CVDs) and specific mechanisms are rarely reported. Hypothesis: Moderate electronic device usage can reduce the risk of CVDs, with the possible mechanisms of cognitive function and personal well-being. Method: Participants from the UK Biobank and CHARLS cohort who were free of the 11 CVDs at recruitment were included. Restricted cubic spline (RCS) analysis was employed to investigate the association between electronic device usage time (not for work reasons) and the hazard ratios (HRs) of CVDs, determining the optimal protective time for grouping. Propensity score matching (PSM) of 1:1 and robust estimation of Cox proportional hazards regression models were utilized to analyze the association between electronic device usage and the risk of CVD incidence, all-cause mortality, and CVD-specific mortality in the UK Biobank, and to reveal the association between internet usage and the risk of CVD in the CHARLS cohort. Mediation analysis and mediation Mendelian randomization (MR) were utilized to screen for potential mediators. Results: Total 479,975 participants from two cohorts were included for final analysis. Among the participants recruited from the UK Biobank, RCS analysis indicated that using electronic devices for exactly 1 hour daily received the lowest HRs of general CVDs (HR: 0.984, P<0.001) and specific subtypes. One hour daily electronic device users exhibited reduced risks of all-cause and CVD-specific mortality. Cox analysis validated that internet usage contributes to the prevention of CVDs after PSM in CHARLS cohort (HR: 0.510, P=0.032). Mediation analysis suggested that protective effect of electronic device usage on CVDs was mediated through promoting health satisfaction, enhancing cognitive function, and reducing depression and anxiety (mediating effect: 12.6%, 19.5%, 7.1%, respectively, all p-values<0.001). The mediating effects were further verified by MR. Conclusion: No working electronic devices usage for one hour a day contributed to CVDs prevention, which might be mediated by cognitive function improvement in middle-aged and older adults.

Introduction: Aldosterone (Aldo) increases sodium and water reabsorption and mediates inflammatory processes. Its relationship to co-morbidities has not been well defined in the general population. Hypothesis: We addressed the hypothesis that plasma aldosterone concentration (PAC) is associated with metabolic and cardiorenal diseases in the general community. Methods: We determined PAC in a general community-based cohort from Olmsted County, MN (n=1,674), and defined correlations with cardiorenal, metabolic diseases and myocardial function and structure. Results: PAC was detected in all subjects and ranged from 2.5 to 91 ng/dl (mean value 6.7 ng/dl, +/- SD 6.6). Multivariate analysis adjusted for age, gender, BMI, ANP and BNP showed highly significant correlations between PAC and hypertension (HTN) (p<.0001, OR=2.28, CI:1.91-2.71), atrial fibrillation (p<.01), chronic kidney disease (CKD) (p<.0001, OR=1.64, CI:1.33-2.02), central obesity (p<.0001, OR=1.61, CI:1.27-2.05), hypertriglyceridemia (p<.003), prevalence of metabolic syndrome (MetS) (p<.0007, OR=1.40, CI=1.15-1.71), obesity (p<.0001, OR=1.48, CI:1.27-1.73), and concentric left ventricular hypertrophy (cLVH) (p=.01). Recognizing that ANP and BNP are known inhibitors of Aldo, we defined the relationship between these cardiac hormones (NTpro-ANP and NT-proBNP) and PAC and observed highly significant inverse relationships with NTpro-ANP (p=0.0009), NTpro-BNP (p=0.0003) in the general population. Conclusions: In conclusion, in the general community, PAC is strongly correlated with renal, metabolic and cardiovascular diseases as well as cardiac remodeling. Specifically, increasing PAC is strongly associated with HTN, CKD, obesity, MetS, cLVH, and lower levels of natriuretic peptides. Our data suggest a key role of Aldo as a possible biomarker and/or mediator of human cardiorenal and metabolic diseases even in the general adult population, prior to overt disease. This study also supports a possible counter regulatory relationship between cardiac natriuretic peptides and PAC. Further studies are warranted to evaluate possible therapeutic interventions targeting Aldo as a strategy to delay disease progression.

Uric Acid and the Risk of Aortic Aneurysm and Dissection: Insights from a Long-Term Prospective Cohort Study of 468,223 Participants in the UK Biobank.

BackgroundGlycotoxicity and lipotoxicity are key pathophysiological mechanisms underlying the development of metabolic associated fatty liver disease (MAFLD). The primary objective of this study is to investigate the association between the newly proposed Plasma-Glycosylated Hemoglobin A1c/High-Density Lipoprotein Cholesterol Ratio (HbA1c/HDL-C ratio) and the risk of MAFLD.MethodsA study population of 14,251 individuals undergoing health examinations was included. The association between the HbA1c/HDL-C ratio and MAFLD was analyzed using multivariable logistic regression and restricted cubic spline (RCS) analysis. Exploratory analyses were conducted to assess variations in this association across subgroups stratified by gender, age, body mass index (BMI), exercise habits, drinking status, and smoking status. The discriminatory value of the HbA1c/HDL-C ratio and its components for screening MAFLD was evaluated using receiver operating characteristic (ROC) curves.ResultsA total of 1,982 (13.91%) subjects were diagnosed with MAFLD. After adjusting for confounding factors, we found a significant positive association between the HbA1c/HDL-C ratio and MAFLD [odds ratio (OR) 1.34, 95% confidence interval (CI): 1.25, 1.44]. No significant differences in this association were observed across all subgroups (All P for interaction > 0.05). Furthermore, through RCS analysis, we observed a nonlinear positive correlation between the HbA1c/HDL-C ratio and MAFLD (P for non-linearity < 0.001), with a potential threshold effect point (approximately 3 for the HbA1c/HDL-C ratio). Beyond this threshold point, the slope of the MAFLD prevalence curve increased rapidly. Additionally, in further ROC analysis, we found that for the identification of MAFLD, the HbA1c/HDL-C ratio was significantly superior to HbA1c and HDL-C, with an area under the curve (AUC) and optimal threshold of 0.81 and 4.08, respectively.ConclusionsOur findings suggest that the newly proposed HbA1c/HDL-C ratio serves as a simple and practical indicator for assessing MAFLD, exhibiting well-discriminatory performance in screening for MAFLD.

ABSTRACT: Background Erectile dysfunction (ED) is associated with metabolic disorders like hypertension and diabetes. The lipid accumulation product (LAP), a marker of visceral fat and dyslipidemia, has not been well studied in relation to ED in these populations. This study examined the relationship between LAP and ED. Methods A cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) 2001–2004 data included 756 men with hypertension or diabetes. Weighted multivariable logistic regression and restricted cubic spline (RCS) analysis evaluated LAP-ED associations, with subgroup analysis for effect modification. Results ED prevalence was 43.65% (330/756). LAP correlated positively with ED risk (continuous: OR = 1.005, 95%CI:1.000–1.005). Highest vs lowest LAP quartile (Q4 vs Q1) showed 2.92-fold higher ED risk (OR = 2.92, 95%CI:1.21–7.06). RCS analysis indicated linear association (P for non-linearity = 0.290). Subgroup analysis showed no significant interactions. Conclusion This study demonstrates a positive correlation between LAP and ED in men with diabetes or hypertension; further studies are needed to confirm findings and explore mechanisms.

To investigate the prognostic value of the systemic inflammation response index (SIRI) for major adverse cardiovascular events (MACE) among adults with metabolic syndrome (MS), and to determine whether MS status modifies the association between SIRI and incident MACE. This prospective cohort study enrolled 3,198 participants from Pudong New Area, Shanghai, with a median follow-up of 43 months. Baseline characteristics were compared across SIRI quartiles stratified by MS status. Multivariable Cox proportional hazards regression models were constructed to evaluate the independent association between SIRI and MACE. Restricted cubic spline (RCS) analysis was performed to examine the dose-response relationship. Interaction analyses were conducted to assess effect modification by key metabolic components. Of 3,198 participants, 1,318 had MS and 1,880 did not. Higher SIRI quartiles were associated with unfavorable metabolic profiles in both groups. Compared with non-MS participants in the lowest SIRI quartile, participants with MS in the highest SIRI quartile exhibited the greatest risk of MACE (HR=2.33, 95% CI: 1.64-3.30, P < 0.001). Among participants with MS, the highest quartile demonstrated a 38% elevated risk compared with the lowest quartile (HR=1.38, 95% CI: 1.08-1.77, P=0.01). RCS analysis indicated a linear positive association between SIRI and MACE risk among participants with MS (P for overall association = 0.02). A significant non-linear interaction was identified between SIRI and fasting plasma glucose (P for interaction = 0.04). Elevated SIRI is independently associated with an increased risk of incident MACE, and MS status significantly modifies this association. SIRI represents a promising and readily available biomarker for cardiovascular risk stratification, especially among individuals with MS. Combined interventions targeting systemic inflammation and glycemic control may reduce the risk of MACE in this high-risk population.

To investigate the relationship between serum lipid levels and the risk of Chronic obstructive pulmonary disease (COPD) in the UK Biobank. We performed this prospective study in 381,938 adults without COPD from UK Biobank. Serum high-density cholesterol (HDL-C), low-density cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), apolipoprotein A (ApoA) and apolipoprotein B (ApoB) were measured and classified into quintiles. Restricted cubic spline (RCS) analysis was applied to visualize the dose-response relationship between lipids and COPD risk and Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). We documented 10,443 incident COPD cases. Nonlinear relationships were found between HDL-C, LDL-C, TC, ApoA, ApoB and COPD risk with RCS analysis (P values for non-linearity < 0.05). Accordingly, multivariable-adjusted regression analysis indicated abnormal HDL-C and ApoA, and low LDL-C, TC and ApoB were associated with increased risk of COPD. Compared to intermediate quintile (Q3) group, both high or low HDL-C and ApoA were associated with risk of COPD. Corresponding HRs (95% CIs) were 1.15 (1.08-1.22), 1.16 (1.09-1.23) in Q1 group and 1.08 (1.01-1.16), 1.07 (1.00-1.14) in Q5 group. For LDL-C, TC and ApoB, there were more than 29% higher risk was observed in Q1 group with HRs (95% CIs) of 1.34 (1.27-1.42), 1.38 (1.30-1.46) and 1.29 (1.21-1.37), while HRs (95% CIs) were 0.88 (0.83-0.94), 0.92 (0.86-0.98) and 0.90 (0.84-0.95) in Q5 groups. We also observed the interactions between specific lipids and age at recruitment, sex and smoking status with stratified analysis. Our study provides the first evidence demonstrating the associations between six major serum lipids and COPD risk, revealing multiple nonlinear relationships. There were U-shaped associations between serum HDL-C, ApoA and COPD risk, and L-shaped associations between LDL-C, TC, ApoB and COPD risk.

BackgroundThe non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel lipid indicator used for assessing the risk of cardiovascular diseases. This study was performed to explore the association between NHHR and the risk of ischemic heart disease (IHD) in type 2 diabetes mellitus (T2DM) patients.MethodsThis large-scale prospective cohort study included 19,925 participants from the UK Biobank. Cox proportional hazards regression models were used to assess the association between the NHHR and the risk of IHD in T2DM participants and restricted cubic spline (RCS) analysis was conducted to assess the dose–response association. Subgroup analysis and several sensitivity analyses were carried out to examine the robustness of our findings.ResultsDuring the follow-up (median 12.7 years), 3,600 T2DM participants developed IHD. The association between the NHHR and the risk of IHD in T2DM participants was significant in the highest NHHR quartile (quartile 4), whereas this association was not stable in quartile 2 or quartile 3. Four sensitivity analyses showed similar results. RCS analysis did not reveal a significant nonlinear relationship between the NHHR indicator and the risk of IHD in T2DM participants (P for nonlinearity = 0.9490). In the subgroup analysis, drinking status was found to have a joint effect with the NHHR on the incidence of IHD in T2DM patients (P for interaction = 0.038).ConclusionsA high level of NHHR is associated with a high risk of IHD in T2DM patients, indicating the great importance of using NHHR in the lipid management of T2DM patients.

Background and aimsThe uric acid-to-HDL-cholesterol ratio (UHR), a novel marker of metabolism and inflammation, has been investigated in various diseases. However, its potential associations with the incidence of cardiovascular disease (CVD) and dyslipidemia remain unclear. This study aimed to examine the relationships between the UHR and the incidence of CVD and dyslipidemia. The primary objective was to evaluate the role of the UHR in predicting CVD and dyslipidemia, whereas the secondary objective was to analyze the predictive effects of the UHR in different subgroups.MethodsWe conducted a cross-sectional analysis using data from the 2001–2018 National Health and Nutrition Examination Survey (NHANES), which included 6,370 adults aged 18–80 years. Weighted binary logistic regression and subgroup analyses were performed to evaluate the independent associations between the UHR and the risk of various cardiovascular conditions, including overall CVD, congestive heart failure, myocardial infarction, angina, coronary heart disease, and dyslipidemia. To investigate potential nonlinear relationships between the UHR and these outcomes, restricted cubic spline modeling was applied to further elucidate the associations.ResultsAmong the 6,370 participants included in the study, 559 were diagnosed with CVD. Elevated UHR values were strongly associated with a greater incidence of CVD and its subtypes, including congestive heart failure, myocardial infarction, angina, and coronary heart disease (all P < 0.001). After accounting for weighted factors, participants in the higher UHR quartiles presented progressively higher rates of CVD: Quartile 1 (4.7%), Quartile 2 (6.3%), Quartile 3 (7.4%), and Quartile 4 (11%). A nonlinear relationship between the UHR and the risk of developing CVD was identified through restricted cubic spline (RCS) analysis. Among the subgroup of 4,117 participants with dyslipidemia, multivariable linear regression analysis demonstrated a significant positive association between the UHR and dyslipidemia (OR 17.38, 95% CI 16.24–18.60). This association remained robust even after adjusting for covariates (OR 11.65, 95% CI 8.995–15.17). RCS analysis further confirmed the nonlinear nature of this relationship. Subgroup analysis revealed no significant interaction between the UHR and overall CVD or CVD-related variables, such as congestive heart failure, myocardial infarction, angina, or coronary heart disease. However, for dyslipidemia, BMI showed a significant interaction, indicating that the positive association between the UHR and dyslipidemia risk is influenced by participants’ BMI.ConclusionA high UHR is associated with an increased risk of various cardiovascular conditions and dyslipidemia. The incorporation of routine UHR monitoring into clinical practice can support the early identification of high-risk individuals, facilitate timely interventions, and reduce the burden of cardiovascular and metabolic diseases.

BackgroundInsulin resistance and dysregulated glucose-lipid metabolism contribute to adverse outcomes in heart failure (HF), yet existing metabolic indicators have limited utility for rapid risk stratification in critically ill patients. The cholesterol, high-density lipoprotein, and glucose (CHG) index may provide a convenient metabolic risk marker in hospitalized HF patients.MethodsThis study adopted a dual-cohort retrospective design. The training cohort included 1,391 patients from the MIMIC-IV database (2008–2019), and the external validation cohort included 296 patients from an independent hospital-based cohort (July 2023 to December 2025). Patients were stratified into quartiles by CHG index. Kaplan–Meier survival analysis, Cox proportional hazards regression models, and restricted cubic spline (RCS) analysis were performed to assess the relationship between CHG index and in-hospital mortality.ResultsIn the training cohort, in-hospital mortality increased from 8.91% in Q1 to 17.87% in Q4 (log-rank test p = 0.0141). In the fully adjusted model, each 1-unit increase in CHG index was associated with a 76.8% increase in in-hospital mortality risk (HR = 1.768, 95% CI 1.337–2.338; p < 0.001). RCS analysis indicated an approximately linear positive association (P for overall < 0.001, P for nonlinearity = 0.139). The external validation cohort showed a similar association, with mortality increasing from 4.05% in Q1 to 16.22% in Q4 and a fully adjusted HR of 2.716 (95% CI 1.483–4.962, p = 0.001).ConclusionThe CHG index was independently associated with in-hospital mortality in patients with HF, with consistent findings in an external cohort. As an integrative biomarker derived from routine laboratory tests, the CHG index may reflect the interplay between metabolic dysregulation and cardiovascular vulnerability, thereby assisting early risk stratification in hospitalized patients with heart failure.

ObjectiveThis study aimed to examine the association between the C-reactive protein-albumin-lymphocyte (CALLY) index and the hypertension prevalence in adults with diabetes.MethodsThis cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) (1999–2010). Adult participants diagnosed with diabetes were included. The CALLY index was calculated based on C-reactive protein (CRP), albumin (ALB), and lymphocyte count (LC) and divided into two groups. Univariate and multivariate logistic regression models were used to evaluate the association between the CALLY index and hypertension prevalence, adjusting for confounders such as age, sex, race, poverty-income ratio (PIR), smoking, and alcohol consumption. Restricted cubic spline (RCS) analysis was performed to explore potential nonlinear relationships.ResultsA total of 4163 diabetic adults were included. A significant inverse association was observed between the CALLY index and hypertension prevalence. In multivariate analysis, after adjusting for confounders, participants in the upper quantile (M2) exhibited a lower hypertension prevalence compared to those in the lower quantile (M1) (odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.71–0.94, p = 0.004). RCS analysis indicated a nonlinear association, with a protective effect of the CALLY index against hypertension.ConclusionThe CALLY index is associated with hypertension prevalence in diabetic adults, integrating inflammatory, immune, and nutritional parameters. CALLY may serve as a potential biomarker for risk stratification; however, causality cannot be inferred due to the cross-sectional study design.

High-sensitivity C-reactive protein (hsCRP) to high-density lipoprotein cholesterol (HDL-C) ratio (CHR) is associated with coronary artery disease (CAD), but its predictive value for long-term adverse outcomes in patients with CAD following percutaneous coronary intervention (PCI) remains unexplored and is the subject of this study. Patients with CAD who underwent PCI at the Korea University Guro Hospital-Percutaneous Coronary Intervention (KUGH-PCI) Registry since 2004 were included. Patients were categorized into tertiles according to their CHR. The end points were all-cause mortality (ACM), cardiac mortality (CM) and major adverse cardiac events (MACEs). Kaplan-Meier analysis, multivariate Cox regression, restricted cubic spline (RCS) and sensitivity analyses were performed. A total of 3260 patients were included and divided into Group 1 (CHR <0.830, N = 1089), Group 2 (CHR = 0.830-3.782, N = 1085) and Group 3 (CHR >3.782, N = 1086). Higher CHR tertiles were associated with progressively greater risks of ACM, CM and MACEs (log-rank, p < 0.001). Multivariate Cox regression showed that patients in the highest tertile had greater risks of ACM (HR: 2.127 [1.452-3.117]), CM (HR: 3.575 [1.938-6.593]) and MACEs (HR: 1.337 [1.089-1.641]) than those in the lowest tertile. RCS analyses did not reveal a significant non-linear relationship between CHR and ACM, CM or MACEs. The significant associations remained significant in the sensitivity analyses, RCS analyses with or without extreme values, subgroup analyses and multiple imputations for missing data. Elevated CHR is a novel, independent risk factor for long-term ACM, CM and MACEs in CAD patients following PCI.

BackgroundAutism spectrum disorder (ASD) imposes a significant burden on both patients and society. Amino acid metabolism abnormalities are particularly relevant to ASD pathology due to their crucial role in neurotransmitter synthesis, synaptic function, and overall neurodevelopment. This study aims to explore the association between amino acid metabolic abnormalities and the severity of ASD by analyzing the amino acid concentrations in the blood of children with ASD.MethodsFasting peripheral blood samples were collected from 344 children with ASD, and amino acid concentrations were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS) while strictly following quality control measures. The association between amino acid concentrations and ASD severity was evaluated using logistic regression and restricted cubic spline (RCS) analysis. The ROC (receiver operating characteristic) curve, decision curve analysis (DCA), and calibration curve were used to construct and validate predictive models and nomograms, thereby assessing their predictive performance.ResultsMultivariate logistic regression analysis showed that aspartic acid (OR = 1.037, 95% CI: 1.009–1.068, P = 0.01), glutamic acid (OR = 1.009, 95% CI: 1.001–1.017, P = 0.03), phenylalanine (OR = 1.036, 95% CI: 1.003–1.072, P = 0.04), and leucine/isoleucine (OR = 1.021, 95% CI: 1.006–1.039, P = 0.01) were significantly positively correlated with the severity of ASD. On the other hand, tryptophan (OR = 0.935, 95% CI: 0.903–0.965, P < 0.01) and valine (OR = 0.987, 95% CI: 0.977–0.997, P = 0.01) were significantly negatively correlated with the severity of ASD. RCS analysis further revealed a nonlinear relationship between the concentrations of aspartic acid, proline, and glutamic acid and the risk of ASD. ROC curve analysis showed that the combined model achieved an AUC (area under the curve) of 0.806, indicating high diagnostic accuracy. Calibration and decision curve analysis further validated the predictive effectiveness and clinical utility of the model.ConclusionsThis study identifies potential amino acid biomarkers that may contribute to ASD severity assessment. Further research is needed to validate these findings and explore their clinical utility.

The association between lung function and headache risk remains unclear. This study aims to explore the association between lung function and headache risk through cross-sectional and longitudinal analyses. This study used data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2015 to 2020 to conduct cross-sectional and longitudinal analyses. The cross-sectional analysis included 10,917 middle-aged and older adults aged ≥ 45years. For the longitudinal component, 5,194 participants from this cohort who had no history of headache diagnosis in the 2015 cross-sectional survey were followed up until 2020. The cross-sectional association between predicted PEF% and headache was examined using multivariate logistic regression and restricted cubic spline (RCS) analysis. For the longitudinal association, Kaplan-Meier curves, multivariable Cox proportional hazards regression models, and RCS analysis were applied to assess the relationship between baseline predicted PEF% levels and the risk of new-onset headache. Additionally, subgroup analyses were performed to explore the consistency of these associations across different subgroups. The results of the multivariate logistic regression analysis showed that the probability of headache decreased with increasing PEF% predicted (P < 0.05); compared with the Q1 group, the Q4 group had a lower probability of experiencing headaches (OR = 0.81, 95% CI 0.68-0.96, P = 0.016). During follow-up, a total of 2,428 people (46.7%) developed new-onset headaches. The results of the multivariable Cox regression analysis showed that an increase in PEF% predicted was a protective factor for the occurrence of headaches, and as PEF% predicted increased, the risk of headaches decreased (P < 0.05); compared with the q1 group, the q4 group had a lower risk of headache (HR = 0.94, 95% CI 0.90-0.97, P < 0.001). Subgroup analysis results showed that gender and PEF% predicted had an interaction effect on headache risk (P = 0.005). In middle-aged and elderly people, especially middle-aged and elderly women, improving PEF levels may have potential value in the primary prevention of headaches.

BackgroundChronic obstructive pulmonary disease (COPD) is associated with an increased risk of coronary artery disease (CAD). However, the role of emphysema, which represents an important structural subtype of COPD, in the development of CAD remains insufficiently clarified. This study aimed to evaluate whether quantitatively assessed emphysema on high-resolution computed tomography (HRCT) independently predicts CAD in COPD patients.MethodsThis retrospective cohort study included 392 COPD patients with no prior history of CAD between 2015 and 2020. All participants underwent HRCT for automated emphysema quantification using 3D Slicer software. Emphysema extent was quantified as the percentage of low attenuation areas (LAA%) below −950 Hounsfield units, with severe emphysema defined as LAA% >16.95%. Logistic regression and restricted cubic spline (RCS) analysis were employed to assess the relationship between emphysema index and CAD, including subgroup and interaction analyses. The ability of the emphysema index to predict CAD was evaluated using receiver operating characteristic (ROC) curves.ResultsSevere emphysema was independently associated with a higher risk of CAD in COPD patients (OR = 2.08, 95% CI: 1.30–3.34; p = 0.002). This association remained robust even after adjusting for confounders (adjusted OR= 2.28, p = 0.005). RCS analysis indicates that the risk of CAD increases with the rise of the emphysema (p for nonlinearity =0.031). The area under the ROC curve for the predictive model was 0.81 (95% CI 0.77, 0.86). Additionally, patients with severe emphysema exhibited significantly more complex coronary lesions, reflected by higher SYNTAX scores (median 10.00 vs 16.29; p = 0.013).ConclusionQuantitative HRCT-based emphysema independently predicts CAD in COPD and demonstrates additive risk with traditional cardiovascular factors. Integrating emphysema quantification with clinical risk assessment improves CAD risk stratification in COPD patients.