Childhood obesity is a growing global health crisis associated with an increased risk of metabolic and cardiovascular diseases in adulthood. While accumulating evidence implicates immune dysregulation in obesity pathogenesis, the specific transcriptional alterations of immune cells, particularly NK cells and T cells in the context of childhood obesity, and their potential as non-invasive diagnostic biomarkers, remain largely unexplored. Here, we investigated the transcriptional alterations of NK cells and T cells in childhood obesity and evaluated their potential as non-invasive diagnostic biomarkers. To this end, we integrated bulk RNA-seq datasets (GSE205668 and GSE87493), adipose single-cell RNA-seq data (GSE159960), and blood qPCR validation to identify NK- and T-cell-related diagnostic biomarkers for childhood obesity. Differential expression analysis and WGCNA were applied to the bulk datasets to derive obesity-associated candidates, and single-cell RNA-seq was used to define immune-cell composition, infer NK-cell pseudotemporal dynamics, and quantify cell-cell communication. Genes shared between the bulk and single-cell analyses were prioritized using an ensemble machine-learning workflow comprising 110 model configurations and five feature-selection methods. TBC1D10C expression was validated by qPCR in an independent cohort of 29 children. Transcriptome-based analyses indicated reduced relative representation of NK cells and T cells in childhood obesity, with altered transcriptional programs and inferred impairment of NK-CD4 + T-cell communication. A 13-gene NK- and T-cell-based diagnostic signature was derived, and TBC1D10C was consistently prioritized by all feature-selection methods. The signature showed good discrimination between childhood obesity and controls across datasets (AUC 0.753-0.808), and comparable performance was observed for TBC1D10C alone. Enrichment analyses associated higher TBC1D10C expression with immune pathways, including Th1/Th2 differentiation, IL-17 signaling, and NK cell-mediated cytotoxicity. qPCR confirmed significant upregulation of TBC1D10C in peripheral blood from children with obesity. Across independent cohorts and platforms, TBC1D10C was identified as a reproducible NK- and T-cell-associated biomarker for childhood obesity, and immune dysregulation relevant to obesity pathophysiology may be reflected by its expression. Therefore, we propose TBC1D10C as a promising diagnostic biomarker and highlight its potential role in the immunopathology of childhood obesity.

The global burden of cardiovascular diseases (CVDs) in adults is increasing. Over the past several decades, CVDs have remained the leading cause of death worldwide. Among CVDs, most mortality estimates are attributed to heart attack and stroke. Another measure of CVDs is disability-adjusted life years, which is the sum of years of life lost and years lived with disability, and provides an index for an estimate of the total number of productive years lost. Therefore, CVDs pose a daunting public health challenge. Several well-known risk factors that substantially contribute to CVDs are preventable, including hypertension, dyslipidemia, diabetes, air pollution, obesity, smoking, physical inactivity, and unhealthy dietary intake. Risk estimation is the foundation of preventive cardiovascular health. CVDs risk calculators for clinical and public estimates are available for this purpose. However, the burden of CVDs and its risk factors vary greatly according to demographics and geographical regions. Therefore, this article describes the burden of CVDs and risk factors in adults according to the World Health Organization's defined regions. Furthermore, emerging CVDs risk factors, population-based prevention approaches, risk estimation calculators, preparation, and manpower issues are discussed.

While adult oral health has been consistently linked to cardiovascular disease, the long-term impact of childhood oral health remains underexplored. Thus, we investigated the association between dental caries and gingivitis in childhood and the incidence of atherosclerotic cardiovascular disease (ASCVD) in adulthood. This nationwide Danish cohort study included 568,778 individuals born between 1963 and 1972, with oral health data from the National Child Odontology Registry (1972-1987) and ASCVD outcomes from the National Patient Register (1995-2018). Dental caries and gingivitis were categorized by severity and trajectory across childhood. Cox regression models stratified by sex, education level, and type 2 diabetes status were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for incident ischemic heart disease, myocardial infarction, and ischemic stroke. Severe childhood dental caries was associated with increased ASCVD incidence in both males (HR 1.32; 95% CI: 1.18-1.50) and females (HR 1.45; 95% CI: 1.25-1.68). High gingivitis scores also predicted elevated ASCVD risk (males: HR 1.21; 95% CI: 1.10-1.32; females: HR 1.31; 95% CI: 1.14-1.50). Disease trajectories with moderate to severe level oral disease and oral health deterioration were significantly associated with higher ASCVD incidence. Within the limitations of this study, poor childhood oral health, particularly persistent or worsening dental caries and gingivitis, is associated with an increased risk of ASCVD in adulthood. These findings highlight the potential of early oral health interventions in reducing long-term cardiovascular risk.

External validation and recalibration of cardiovascular risk scores for prediction of 10-year risk of fatal cardiovascular disease: a prospective, observational, population-based cohort analysis of adults in Mexico City.

Endothelial dysfunction is a central feature of cardiovascular disease (CVD) and reflects the maladaptive integration of hemodynamic, metabolic, and inflammatory cues within the vascular microenvironment. The endothelial Notch signaling pathway has emerged as a conserved regulatory pathway whose output is highly dependent on cellular context. While its developmental roles are well established, how endothelial Notch integrates mechanical, inflammatory, and metabolic cues in adult CVD remains incompletely defined. Addressing this gap is essential for understanding why both excessive and insufficient Notch activation are associated with cardiovascular pathology. This review synthesizes current evidence defining the mechanistic regulation of endothelial Notch signaling and contextualizes its dysregulation across major CVD phenotypes, highlighting the need for precision-based therapeutic strategies that restore physiological Notch signaling without global pathway suppression.

Early identification of individuals at elevated risk of cardiovascular disease and preventive treatment during childhood may reduce cardiovascular disease in adults with chronic inflammatory diseases. Children with atopic dermatitis (AD) may have elevated cardiovascular risk, but studies to date have not accounted for heterogeneity in disease activity and severity across childhood. To evaluate whether active and more severe AD across childhood and adolescence are associated with cardiovascular risk. This longitudinal cohort study used data collected from 1991 to 2017 for the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in the United Kingdom. Participants included children alive at 1 year with assessment of AD and at least 1 cardiovascular disease risk factor at a minimum of 1 time point. Data were analyzed November 30, 2022, to February 20, 2025. Repeated assessments of AD activity and severity across childhood and adolescence. The primary outcome was cardiometabolic risk scores calculated at ages 15, 17, and 24 years. Secondary outcomes included body mass index, blood pressure, and lipid profiles measured up to 12 times between ages 3 and 24 years and ultrasonography measures of subclinical atherosclerosis at ages 17 and 24 years. The subcohort included 9281 children, of whom 4669 (50.31%) were male. The analysis included 1001 participants (10.79%) 3 years of age, 908 (9.78%) 4 years, 838 (9.03%) 5 years, 6352 (68.44%) 7 years, 6205 (66.86%) 10 years, 5629 (60.65%) 11 years, 4968 (53.53%) 13 years, 3502 (37.73%) 15 years, 4738 (51.05%) 17 years, and 3626 (39.07%) 24 years of age. The prevalence of active AD varied by age and ranged from 13.10% to 21.58% at ages 3 through 18 years. Among participants with AD, 3.52% to 6.85% reported moderate or severe disease at each age. Multivariable linear regression models did not reveal associations between active AD and most cardiovascular risk factors; only 2 associations between AD and low-density lipoprotein cholesterol levels were found with P < .05, but they differed in the directionality of association at ages 3 and 10 years (mean difference, -0.33 [95% CI, -0.58 to -0.07] SDs for 3 years vs 0.14 [95% CI, 0.03-0.24] SDs at 10 years). There was no consistent evidence for dose-response effects by AD severity. There were also no associations between patterns of more active and severe AD across childhood with subclinical atherosclerosis. In a population-based UK cohort of children and adolescents followed up into early adulthood, AD, including more active and severe disease over time, was not associated with increases in markers of cardiovascular risk. This finding suggests that systematic screening of all children with AD is unlikely to improve identification of early cardiovascular risk.

Background: Childhood hypertension is an important predictor of adult cardiovascular disease. Idiopathic erythrocytosis in adolescent males is characterized by elevated hemoglobin and hematocrit levels, which may increase blood viscosity and potentially influence blood pressure (BP) regulation. However, the relationships between erythrocytosis, renal tubular-glomerular function, and systemic hypertension in adolescents remain unclear. Methods: This prospective observational case-control study was conducted between October of 2023 and April of 2024, including 37 male adolescents with idiopathic erythrocytosis and 24 age-matched healthy male controls. Complete blood count parameters were confirmed using two samples obtained at separate time points. Biochemical, urinalysis, tubular phosphorus reabsorption, and fractional excretion of sodium tests were performed to assess renal tubular and glomerular function, and 24 h ambulatory blood pressure monitoring (ABPM) was performed in all participants and interpreted according to the 2022 American Heart Association recommendations. Results: The mean systolic and diastolic BP values measured via ABPM did not differ significantly between the groups. However, adolescents with idiopathic erythrocytosis demonstrated significantly higher systolic and diastolic BP load values during 24 h, daytime, and nighttime periods when compared with healthy controls (p < 0.05). Renal tubular and glomerular function parameters were similar between groups. Hematocrit levels showed significant correlations with multiple ABPM load parameters. In the multivariable linear regression analysis, hematocrit remained independently associated with 24 h systolic BP load after adjustment for age, BMI, and serum creatinine. Conclusions: Adolescent males with idiopathic erythrocytosis exhibited increased ambulatory BP load despite similar mean BP values to controls. Elevated hematocrit may contribute to early alterations in BP regulation in adolescents with idiopathic erythrocytosis.

The bidirectional relationship between asthma and cardiovascular disease (CVD) among aging populations remains insufficiently explored, especially regarding potential mediating mechanisms. The objective of this study is to explore the bidirectional effects between asthma and CVD, with focus on frailty as a potential mediator. We utilized longitudinal data (2011–2018) from the China Health and Retirement Longitudinal Study (CHARLS) to analyze two cohorts: 7,910 CVD-free participants and 8,897 asthma-free participants. Frailty was evaluated based on a 29-component frailty index (FI). Bidirectional associations were examined using Cox proportional hazards regression models, with progressive adjustments for sociodemographic, lifestyle, and clinical variables. Mediation analysis assessed the mediating role of FI, utilizing bootstrap methods. baseline asthma correlated with a 74.6% heightened risk of new-onset CVD (HR = 1.746, 95% CI: 1.351–2.256) after full adjustment, whereas baseline CVD correlated with a 62.1% heightened risk of developing incident asthma (HR = 1.621, 95% CI: 1.207–2.176). Bidirectional associations were examined using Cox regression models. FI accounted for 15.57% of the relationship between CVD and asthma, as indicated by the mediation analysis (indirect effect = 0.005, 95% CI: 0.002–0.007), but did not mediate the opposite pathway. Subgroup analyses revealed consistent effects across demographic and clinical subgroups (all interaction p > 0.05). This research offers new insights into bidirectional associations between asthma and CVD in older Chinese adults, with partial mediation by frailty in the CVD→ asthma pathway. Findings highlight the need for integrated management and suggest frailty may serve as a target for intervention.

Objective: To evaluate the association between triglyceride glucose (TyG) index and its novel composite metabolic indexes combined with obesity-related indexes and cardiovascular disease (CVD) risk in middle-aged and old adults in China. Methods: Based on data from the China Health and Retirement Longitudinal Study from 2011 to 2020, a study was conducted in 6 158 middle-aged and old adults without CVD at baseline survey. Cox proportional hazard regression model was used to assess the association of each indicator with the risk for CVD. Kaplan-Meier curve and restricted cubic spline (RCS) were also used to explore the dose-response relationship and nonlinear trends. Subgroup analyses were used to test the stability of the association in people with different demographic characteristics. Results: A total of 1 639 CVD events occurred during the 9-year follow-up period. After adjusting for confounding factors, high levels of TyG index and its combined obesity index were significantly associated with an increased risk for CVD. Compared with the Q1 group, the HRs (95%CIs) of TyG, TyG-BMI, TyG-waist-to-height ratio (WHtR), and TyG-weight-adjusted-waist index (WWI) were 1.36 (95%CI: 1.19-1.57), 1.74 (95%CI: 1.51-2.01), 1.55 (95%CI: 1.34-1.79), and 1.38 (95%CI: 1.20-1.60) in the Q4 group, respectively. RCS analysis showed that TyG and TyG-BMI had linear association with the risk for CVD, whereas TyG-WHtR and TyG-WWI had non-linear association with the risk for CVD. Subgroup analyses suggested that the associations were in good agreement in people in different age, sex, education level and hypertension status group (all P for interaction >0.05). Conclusions: The TyG index combined with obesity index is significantly associated with the risk for CVD in middle-aged and old adults in China. Paying attention to the TyG index and obesity index in the middle-aged and old adults can benefit the prevention and treatment of CVD and other chronic diseases in the elderly in China.

The cardiometabolic index (CMI), which integrates lipid metabolism and central obesity measures, has uncertain value for predicting cardiovascular disease (CVD). We evaluated the association between CMI and incident CVD in Chinese adults. Data were drawn from the China Health and Retirement Longitudinal Study. We selected 7830 adults aged ≥45 years who were free of CVD at the 2011 to 2012 baseline and followed them in 2013, 2015, and 2018. CMI was calculated as (waist circumference/height) × (triglycerides/high-density lipoprotein cholesterol). Incident CVD during follow-up was the primary outcome. Multivariable logistic regression estimated odds ratios and 95% confidence intervals, and restricted cubic spline models assessed nonlinear associations. Stratified analyses examined effect modification. In total, 54.9% of participants were female, the mean age was 58.7 years (standard deviation 8.8), and the mean CMI was 1.89 (0.23). During the 7-year follow-up, 1914 individuals (24.4%) developed CVD. Higher CMI was associated with increased CVD risk after multivariable adjustment (odds ratio = 1.39; 95% confidence interval: 1.11–1.96; P = .017). Interactions were observed for diabetes status and current alcohol consumption. Restricted cubic spline analysis showed a nonlinear increase in CVD risk with rising CMI (P for nonlinearity = .002). Higher CMI was significantly associated with incident CVD in middle-aged and older adults, with a nonlinear rise in risk as CMI increased.

Association of triglyceride-glucose index combined with Chinese visceral adiposity index and cardiovascular diseases in middle-aged and older adults: a cohort study.

ObjectivesAdults with type 1 diabetes (T1D) are at markedly elevated risk of atherosclerotic cardiovascular disease (ASCVD). Guidelines recommend statin use for ASCVD prevention in diabetes between the ages of 40 and 75 years. This study aimed to evaluate statin prescribing rates for primary and secondary prevention of ASCVD in this age range with T1D and to identify disparities and barriers to optimal statin use.Study design, setting, and participantsA retrospective cross-sectional study of 266 adults with T1D aged 40–75 years was conducted at an integrated health system between 2020 and 2024. Demographic features, statin prescribing patterns, low-density lipoprotein (LDL) cholesterol levels and use of additional lipid-lowering agents were extracted from medical records. Barriers to prescribing were identified via endocrine physician documentation.ResultsAmong 266 adults with T1D aged 40–75 years, only 43.2% (95% CI 0.37 to 0.49) were prescribed guideline-recommended statin and 39.3% of those with a history of ASCVD received a high-intensity statin. Overall, 47.7% (95% CI 0.42 to 0.54) of patients achieved the latest LDL cholesterol targets, and 53.0% (95% CI 0.47 to 0.59) if using pre-2023 targets. Deferral to another healthcare professional (23.3%), statin intolerance (15.8%), and clinical inertia (9.0%) were the most common barriers to therapy. In multivariable analyses, female sex was independently associated with lower odds of receiving guideline-recommended statin therapy (aOR 0.45, 95% CI 0.24 to 0.85, p=0.015) and lower odds of achieving LDL targets (OR 0.43, 95% CI 0.28 to 0.64, p=0.046), while ASCVD history was associated with higher odds of statin use (aOR 2.75, 95% CI 1.34 to 5.57, p=0.005). Very few patients received adjunctive lipid-lowering agents (ezetimibe 4.1%, PCSK9 inhibitor 0.4%, none on bempedoic acid).ConclusionsNotable gaps exist in statin prescribing and LDL goal attainment among adults with T1D, particularly women. Efforts to enhance care coordination, promote healthcare professional education and expand the use of adjunctive lipid-lowering therapies may help improve cardiovascular prevention in this high-risk population.

Sarcopenia and dyslipidemia are established as independent risk factors for cardiovascular disease (CVD). The study aims to investigate the joint effect of sarcopenia and lipid parameters on the risk of self-reported cardiovascular disease in individuals with different stages of glucose metabolism. This study included 9053 China Health and Retirement Longitudinal Study (CHARLS) 2015 participants aged ≥ 45 years without baseline CVD. Using multivariable logistic regression, it assessed sarcopenia-lipid-CVD event links, stratified by glucose metabolism. Risk reclassification used combined sarcopenia-lipid status. Restricted cubic splines detected non-linear lipid-CVD relationships. Receiver operating characteristic curves (ROC) evaluated lipid metric accuracy. A total of 1074 participants (11.9%) reported new-onset CVD. Joint exposure analysis identified synergistic effects: sarcopenia combined with elevated lipid parameters (except HDL-C) conferred the highest CVD risk, particularly in normoglycemic (NGR) and prediabetic (Pre-DM) subgroups (p < 0.001), but not in Type 2 diabetics (p > 0.05). ROC analysis revealed modest discriminative ability of non-traditional indices compared with conventional parameters across glycometabolic strata. Atherogenic Coefficient demonstrated relatively consistent, yet limited, predictive capability across glycometabolic states and may warrant consideration as a potential lipid biomarker for CVD risk assessment. The findings highlight the coexposure effects between sarcopenia and lipid parameters on cardiovascular diseases, especially for individuals with normal glucose regulation and prediabetes.

Traditional cardiovascular disease (CVD) risk models may fail to adequately capture the interactions among metabolic factors. We evaluated the combined and mediating associations of the triglyceride-glucose (TyG) index and uric acid (UA) with incident CVD in Chinese adults. Using data from the nationally representative China Health and Retirement Longitudinal Study, we included 9,353 participants aged ≥ 45 years without baseline CVD or cancer, whose fasting triglycerides, glucose, and UA were measured in 2011, and who were followed up through 2020. TyG was calculated as ln [triglycerides (mg/dL) × glucose (mg/dL)/2]. Incident CVD (including myocardial infarction, coronary heart disease, angina pectoris, congestive heart failure, or stroke) was ascertained via standardized self-reported questionnaires. Cox proportional hazards models were used to quantify the relationship between TyG index/UA level, their combination categories and CVD events. Kaplan-Meier curves were used to illustrate the time-dependent association and synergistic effect of TyG index and UA on CVD-related outcomes. Age subgroup classification was used to analyze the effects of two biomarkers on CVD at different ages. Mediation analysis was conducted to assess the direct and indirect associations between two biomarkers and CVD events. During the 9-year follow-up, 2505 (26.8%) individuals developed CVD, including 1745 (18.7%) cases of CHD and760 (8.1%) cases of stroke. Compared with TyG < median (8.59) and UA 4-5 mg/dL, higher TyG and higher UA were each associated with greater CVD risk (fully adjusted HR = 1.146 for TyG ≥ median and HR = 1.167 for UA > 6 mg/dL, all P < 0.05). The joint category of TyG ≥ median and UA > 6 mg/dL showed the strongest association, especially for stroke (fully adjusted HR = 2.193). Elevated TyG and UA levels jointly increased the cumulative incidence of CVD (41.1%), coronary heart disease (31.5%), and stroke (119.3%) relative to the reference group. Synergy was most evident at ages 45-59 and was not significant at ≥ 70 years. Mediation analyses supported a bidirectional pathway: TyG affected CVD via UA and UA affected CVD via TyG. The TyG index and UA levels independently and synergistically increase CVD risk in middle-aged and elderly Chinese adults, with the strongest synergistic effect observed in middle-aged individuals (45-59 years). A bidirectional mediating relationship exists between the TyG index and UA in their effects on CVD. Combined assessment of the TyG index and UA may improve CVD risk stratification, supporting more refined clinical and public health interventions for CVD prevention.

A BSTRACT Background: Adolescents who are overweight or obese are more likely to develop non-communicable diseases (NCDs) in their early adult years, including diabetes, cardiovascular disease, hypertension, and dyslipidaemia. To address the growing epidemic of childhood and adult obesity, immediate action is needed. Obesity and the prevalence of non-communicable diseases are strongly linked to eating habits. Methodology: A pre-tested, validated questionnaire was circulated among undergraduate MBBS students from various medical colleges. Results: One hundred seventy MBBS students from four other medical colleges participated in this online survey. The questionnaire was circulated via Google Forms. The mean age of participants was 21.57 (+1.47). Zomato (57, 33%) and Swiggy (52, 31%) were the most used applications by the participants. One hundred thirty-four (79%) participants had incorrect knowledge about added sugar in the diet cola drinks. One hundred nineteen (70%) participants had incorrect knowledge about added salt in bread. Thirty-five of 107 (33%) females had a waist hip ratio (WHR) of more than 0.85, and 15/63 (24%) males had a WHR of more than 0.90, which implies an increased chance of obesity, cardiovascular risks, and other non-communicable diseases in the future. Conclusion: The study reveals a high prevalence of HFSS food consumption among undergraduate medical students, with online food delivery platforms playing a central role in facilitating this dietary behaviour.

Introduction: Patients with serious cardiovascular diseases (CVDs) can be treated at a few facilities, and often require long distance transport. However, it requires extensive medical equipment. When alternatives are lacking, clinicians may request the Self-Defense Forces to transport these patients under “disaster relief” protocols. In this study, we compared adult and pediatric CVD cases transported by the Air Medical Evacuation Squadron (AMES). Methods: Eighteen pediatric and 13 adult cases of CVD evacuated by AMES between 2006 and 2023 were reviewed, with the medical records. Each patients’ age, main disease, purpose of transportation, evacuation distance, and use of mechanical ventilators or extracorporeal membrane oxygenation (ECMO) were examined. Results: The average age was 2.0 ± 3.9 (0–13) years for children and 50.2 ± 17.8 (22–99) years for adults. The most prevalent disease was cardiomyopathy (15 children and four adults (83.3% vs. 30.8%, respectively; p&lt;0.001), followed by heart failure (HF) zero children and seven adults (0% vs. 53.8%, respectively; p&lt;0.001). The reason for transport was placement of a ventricular assist device (VAD) in 16 children and 11 adults (88.9% vs. 84.6%, respectively; p=0.13). The evacuate distance was 447.2 ± 232.0 miles in children and 358.5 ± 201.3 miles in adults (p=0.97), of whom three children and one adult traveled more than 600 miles. Thirteen children and nine adults (72.2% vs. 69.2%, respectively; p=0.15) were fitted with a ventilator, of whom six children and six adults (46.1% vs. 66.7%, respectively; p=0.021) were placed on ECMO. Conclusion: In cases of severe CVD transported by AMES, the most prevalent CVDs were cardiomyopathy and HF in children and adults, respectively. More adults than children were placed on ECMO. The majority of adults and children with CVD were transported for the installation of VAD.

How early adversity shapes adult physical health: Structural disadvantage and gendered pathways to cardiovascular risk.

Preeclampsia (PE), fetal growth restriction (FGR), and gestational diabetes mellitus (GDM) complicate approximately 15-20% of pregnancies and represent major contributors to perinatal morbidity, mortality, and long-term cardiovascular risk in offspring. Increasing evidence from longitudinal cohort studies indicates that adult cardiovascular disease, including hypertension, coronary artery disease, and stroke, may be programmed in utero through early alterations in fetal cardiac structure and function. Two-dimensional speckle-tracking echocardiography (2D-STE) has emerged as the most sensitive non-invasive technique for detecting subclinical myocardial deformation, often preceding abnormalities detected by conventional Doppler or biometric parameters. While numerous third-trimester studies have demonstrated impaired global longitudinal strain (GLS), altered ventricular geometry, and diastolic dysfunction in established disease, data from mid-gestation (18-28 weeks), the critical preclinical window, remain extremely limited. Therefore, this review aims to systematically synthesize the available evidence on fetal cardiac deformation parameters assessed by 2D-STE at mid-gestation in pregnancies that subsequently developed PE, FGR, or GDM, in order to identify the earliest detectable signatures of fetal cardiovascular programming and highlight key knowledge gaps that must be addressed prior to clinical implementation.

Insulin resistance (IR) is a significant risk factor for cardiovascular disease (CVD), yet practical biomarkers for long-term IR assessment are limited. The triglyceride glucose-waist-to-height ratio (TyG-WHtR) index, integrating lipid/glucose metabolism and central obesity, offers a novel composite marker. We investigated the association between cumulative average TyG-WHtR and incident CVD in middle-aged and older adults. This prospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). Participants aged ≥45 years without baseline CVD were included (n = 5,328). Cumulative average TyG-WHtR was calculated from Wave 1 (2011) and Wave 3 (2015) using the formula: [TyG × WHtR], where TyG = ln[(TG mg/dL × FBG mg/dL)/2] and WHtR = waist circumference (cm)/height (cm). Incident CVD was defined as new self-reported physician-diagnosed heart disease/stroke or active treatment during follow-up. Multivariable logistic regression and restricted cubic spline models assessed associations, adjusting for demographics, lifestyle, cardiometabolic risk factors, and comorbidities. Over 4 years, 568 (10.7%) participants developed CVD. Higher cumulative average TyG-WHtR quartiles showed progressively increased CVD incidence (Q1: 7.4%, Q4: 13.3%; P-trend<0.001). After full adjustment, participants in Q2-Q4 had significantly higher CVD risk versus Q1 (Q2: OR=1.451, 95% CI: 1.095-1.928; Q3: OR=1.427, 1.066-1.917; Q4: OR=1.436, 1.035-2.000). Each 1-SD increase in TyG-WHtR was associated with a 18.3% higher CVD risk (OR=1.183, 95% CI: 1.052-1.332). A linear dose-response relationship was observed (P for overall = 0.018, P for nonlinear = 0.409), particularly for heart disease (P for overall = 0.010). Results remained consistent across subgroups (age, sex, smoking, comorbidities) and sensitivity analyses. Cumulative average TyG-WHtR independently predicts incident CVD in middle-aged and older Chinese adults. The cumulative average TyG-WHtR index may serve as a potential practical tool for early identification of individuals at elevated cardiovascular risk.

Drawing on a large, nationally representative population of older American adults (n = 3610), the study shows that individuals with more than eight missing teeth have a 6%-10% higher likelihood of cardiovascular disease compared with those with fewer tooth losses. Poorer diet quality emerged as a key pathway linking tooth loss and cardiovascular outcomes.