The triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance, but the clinical relevance of its longitudinal dynamics remains unclear. This study aimed to evaluate whether visit-to-visit variability in TyG (TyG-CV) and longitudinal change in TyG (TyG-Slope) were associated with early carotid plaque progression and improved risk prediction beyond conventional factors and mean TyG. In this single-centre retrospective longitudinal cohort, 1,519 adults aged 18–65 years who completed three annual examinations from 2023 to 2025 were included. Fasting triglycerides and fasting plasma glucose were measured from overnight fasting venous blood samples using standardized laboratory assays, and the TyG index was calculated at each visit. Carotid plaque and plaque area were assessed by standardized carotid ultrasonography. TyG-CV was calculated as SD/mean × 100

BackgroundHeart failure with preserved ejection fraction (HFpEF) is characterized by normal ejection fraction and diastolic dysfunction. The role of plasma homocysteine (Hcy) levels in HFpEF has been understudied, though elevated levels are known to affect cardiovascular health.MethodsThis retrospective observational study analyzed 80 HFpEF patients and 80 matched controls without HFpEF. Fasting plasma Hcy levels were measured using a dual-antibody sandwich enzyme-linked immunosorbent assay (ELISA). Standard echocardiographic evaluations were performed to measure interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), and the early-to-late diastolic mitral inflow velocity ratio (E/A). Statistical analyses included independent sample t-tests, chi-square tests, Pearson's correlation, and Spearman's rank correlation.ResultsHFpEF patients exhibited significantly higher plasma Hcy levels (45.17 µmol/L) compared with controls (33.85 µmol/L, p < 0.001). Although LVEDD and LVEF did not differ significantly between groups, HFpEF patients demonstrated increased IVST, LVPWT, LAD, and a higher E/A ratio (p < 0.01 for all). Plasma Hcy levels were inversely correlated with LVEF (r = –0.375, p = 0.012) and positively correlated with IVST (r = 0.53), LVPWT (r = 0.45), LAD (r = 0.43), and E/A ratio (r = 0.56; p < 0.01 for each). A strong positive correlation was also observed between Hcy levels and New York Heart Association (NYHA) classification (r = 0.824, p < 0.001).ConclusionsThe findings indicate that elevated plasma homocysteine is associated with myocardial remodeling and impaired diastolic function in HFpEF patients. These results support the potential role of homocysteine as a biomarker for HFpEF severity and progression, warranting further investigation into its utility for risk stratification and targeted therapy.

Background The association between the common carotid artery (CCA) diameter and cardiovascular disease (CVD) is recognized, but the precise nature of this link remains elusive. This study aimed to investigate the potential relationship between CCA diameter and the risk of CVD mortality in a large population in northeast China. Methods The current study included 5668 participants (mean age 58.9 ± 10.1 years) from a population-based study conducted in rural areas of northeast China between September 2017 and May 2018. Information on death was collected from baseline until July 31, 2022. The CCA inter-adventitial diameter was measured using ultrasound. Cox proportional-hazard models were employed to explore the relationship between the common carotid artery diameter and cardiovascular mortality. Results At baseline, the mean CCA diameter (mm) of subjects was 7.30 ± 0.99 and increased significantly with age, ranging from 6.65 ± 0.71 among people 40–49 years to 7.99 ± 1.04 among people ≥ 80 years. CCA diameter was significantly larger in males compared to females (7.51 ± 1.03 versus vs. 7.16 ± 0.94; P < 0.001). A total of 185 participants died of CVD during a median follow-up of 4.48 years. CCA diameters were divided into quartiles, and the highest quartile of carotid diameter (≥ 8.06 mm) had a 2.29 (95% confidence interval [CI]: 1.24, 4.22) times higher risk of CVD mortality than the lowest quartile (≤ 6.65 mm) ( P < 0.01) in the fully adjusted model. Each increase in the diameter of the common carotid artery (per SD) raised the risk of cardiovascular death by 36% (hazard ratio [HR]: 1.36; 95% CI: 1.18, 1.57). The subgroup analysis results demonstrated that a per SD increase was associated with a 42% increased risk of CVD mortality in participants aged ≥ 64 years in the fully adjusted model (HR: 1.42; 95%CI: 1.21, 1.66). Conclusions Our study indicates the possible incremental value of CCA diameter in optimizing the risk stratification of cardiovascular disease and provides essential insights into reducing the burden of cardiovascular disease.

Background: The atherosclerotic process can cause compensatory enlargement of artery diameter. However, the association between common carotid artery (CCA) diameter and stroke remains unclear. Methods: This cross-sectional study included 5668 participants >= 40 years of age residing in rural northeast China, in whom the inter-adventitial diameter of CCA was measured. The association between CCA diameter and stroke prevalence was explored using multivariate logistic regression and concentration-response relationship in females and males, respectively. Results: CCA diameter (mm) was greater in stroke than in non-stroke populations in both males (7.73 versus [vs.] 7.49; P < 0.05) and females (7.69 vs. 7.13; P < 0.001). Among males, when dividing CCA diameters into quartiles, the second quartile (6.86-7.5 mm) had a 1.64 times higher risk for stroke than the bottom quartile (< 6.85 mm) (P < 0.05) in the adjusted model. In females, the top quartile (> 7.95 mm) had a 2.08 (1.07-4.04) times higher risk than the bottom quartile (< 6.50 mm) (P < 0.01) (overall trend 1.19 [1.00-1.43]). Moreover, dose-response relationship confirmed correlations between CCA diameter and stroke in females (P < 0.05). The net reclassification index (NRI) and integrated discrimination index (IDI) confirmed the incremental value of CCA diameter in predicting probability of stroke in females (NRI 0.353 [95% confidence interval (CI) 0.198-0.497], P < 0.001; IDI 0.004 [95% CI 0.001-0.006], P < 0.01) and males (NRI 0.201 [95% CI 0.158-0.241], P < 0.001; IDI 0.005 [95% CI 0.001-0.009], P < 0.01). Conclusions: This study highlighted the incremental value of CCA diameter in optimizing risk classification and stroke prevention in a Chinese population.

目的 探讨辽宁省农村地区动脉粥样硬化患病率及影响因素,为进一步干预及降低心血管疾病负担提供理论依据.方法 本横断面研究于2017年9月-2018年5月在朝阳县和凌源市进行,采用问卷调查、体格检查及实验室检查的方式对5 838名≥40岁的常住居民进行研究,分析动脉粥样硬化的患病率和影响因素.结果 辽宁省农村地区动脉粥样硬化粗患病率为42.1％,标化患病率为33.1％,男性显著高于女性,男性参与者标化患病率为40.0％,女性为29.2％,随年龄增加呈明显增长.根据多因素logistic回归分析结果,年龄增高、男性(OR= 1.72,95％CI:1.42～2.06)、现吸烟(OR=1.63,95％CI:1.35～1.96)、既往吸烟(OR= 1.34,95％CI:1.05～1.71)、缺乏运动(OR=1.22,95％CI:1.01～1.46)为动脉粥样硬化的危险因素.结论 辽宁省农村地区动脉粥样硬化患病率较高,合并危险因素较多,尤其男性患者,心血管负担较为沉重,有效控制动脉粥样硬化及危险因素是目前亟待解决的关键问题.

Objective: Carotid atherosclerosis is a known marker of increased cardiovascular risk. We aimed to assess the current epidemiology of carotid atherosclerosis, carotid plaque and related risk factors in rural northeast China. Methods: The population-based, cross-sectional study was conducted in 5,838 adults aged ≥40 years residing in rural northeast China in 2017–2018. A multi-stage cluster sampling method was used to select the representative sample. Carotid atherosclerosis was defined as carotid intima-media thickness (CIMT) ≥1.0 mm or presence of plaque. Results: The mean CIMT was 0.72 ± 0.13 mm and increased with age in this population. Among 2,457 individuals with carotid atherosclerosis, 2,333 were diagnosed with carotid plaque, and 210 individuals were moderate or severe carotid stenosis. Crude prevalence of carotid atherosclerosis and plaque were 42.1 and 40.0%, significantly higher in men than in women ( p < 0.001). The age-standardized prevalence of carotid atherosclerosis and carotid plaque were 33.1 and 31.5%, respectively. Advancing age, men, hypertension, diabetes, current smoking, ever-smoking and lack of exercise were risk factors for carotid atherosclerosis. Hypertension (69.1%), dyslipidemia (26.0%) and diabetes (16.1%) were highly prevalent in participants with carotid atherosclerosis. However, the control rates of those comorbidities were frustratingly low (4.7, 8.2, and 14.2%, respectively). Conclusions: The high prevalence of carotid atherosclerosis, carotid plaque, carotid stenosis and uncontrolled risk factors indicated the high burden of cardiovascular disease in rural northeast China, particularly in men. Strategies of prevention and management of atherosclerosis and related risk factors were urgently needed in rural northeast China.

目的 探讨无心血管风险因素中老年人群颈动脉粥样硬化情况及其相关危险因素,为降低心血管疾病负担提供依据.方法 于2017年9月-2018年5月,采用分层、整群抽样的方法选取调查对象,对辽宁省朝阳县和凌源市≥40岁的1 449名无心血管危险因素的常住居民进行问卷调查、体格检查及实验室检查.无心血管风险因素人群定义采用Adult Treatment PanelⅢ标准.应用SPSS 21.0统计软件进行x2检验、趋势x2检验和多因素logistic回归分析.结果 无心血管风险因素人群中,颈动脉粥样硬化患病率为23.4％,男性(37.1％)显著高于女性(20.1％),差异有统计学意义(P＜0.05).颈动脉粥样硬化患病率随年龄增加呈明显增加趋势(趋势x2=62.068,P＜0.01).多因素logistic回归分析结果表明,年龄较大(与40～49岁组比较,50～59岁、60～69岁、70～79岁、≥80岁组的OR值分别为2.63、7.62、17.29和53.99)、男性(OR=1.87,95％CI:1.26～2.77)、高糖化血红蛋白(OR=1.90,95％CI:1.20～3.02)、高脉压差(OR=1.03,95％CI:1.01～1.05)及高密度脂蛋白胆固醇升高(OR=2.31,95％CI:1.75～3.04)与患颈动脉粥样硬化高风险相关.结论 无心血管危险因素的中老年人群颈动脉粥样硬化患病率高,高年龄、男性、高糖化血红蛋白、高脉压差和升高的高密度脂蛋白胆固醇与动脉粥样硬化相关.提示在老年人、男性及糖化血红蛋白水平轻微增高的人群中,即使无心血管危险因素,也应该注意动脉粥样硬化的监测.

Objective: Individuals without conventional cardiovascular risks (CVRFs) still have the risk of adverse outcomes, and subclinical carotid atherosclerosis is a known predictor of cardiovascular events. We aimed to assess the prevalence and associated risk factors of subclinical carotid atherosclerosis in CVRF-free population. Methods: The cross-sectional study was conducted in rural northeast China in 2017-2018. CVRFs freedom was defined as untreated blood pressure < 140/90 mmHg, fasting plasma glucose < 7.0 mmol/L, untreated total cholesterol < 6.22 mmol/L, low-density lipoprotein cholesterol < 4.14 mmol/L, high-density lipoprotein cholesterol (HDL-C) ≥ 1.04 mmol/L, and no current smoking. This subgroup population included 1449 individuals, and ultrasound was used to detect carotid atherosclerosis. Results: The mean carotid intima-media thickness is 0.74 ± 0.14 mm. The prevalence of carotid plaque is 23.4% (95%CI: 21.2%-25.6%) among CVRFs-free population, significantly higher in men than in women (37.1% vs 20.0%, p<0.001), and rises steeply with advancing age. 1.31% have moderate-to-severe carotid stenosis. Advancing age, man, glycosylated hemoglobin (OR, 1.90; 95% CI, 1.20-1.32), HDL-C level (OR, 2.31; 95% CI, 1.75-3.04), and pulse pressure (OR, 1.03; 95% CI, 1.01-1.05) are potentially related to presence of carotid atherosclerosis. Adjusted-dose-response association shows a linear relationship between HDL-C and prevalence of carotid atherosclerosis. Conclusions: The prevalence of subclinical carotid atherosclerosis in CVRF-free population was relatively high, indicating poorly defined factors might contribute to the early atherogenesis. Moreover, we observed a paradoxical response between subclinical carotid atherosclerosis and HDL-C levels, suggesting that treatment targeting to increase HDL-C levels might not reduce future cardiovascular risks.

The relationship between subclinical left ventricular (LV) dysfunction and atherosclerosis may have been underestimated in the past, which might be responsible for the high incidence of premature death in individuals with carotid stenosis. We sought to evaluate the underlying myocardial dysfunction in asymptomatic carotid stenosis patients using speckle tracking echocardiography (STE). Fifty patients with carotid stenosis ≥ 50% and a preserved LV ejection fraction (LVEF), and 45 controls without carotid stenosis who were matched in terms of vascular comorbidities were enrolled. All participants underwent carotid ultrasound and echocardiographic examination. The global LV longitudinal strain (GLS) was measured using STE. Compared with the control group, the e’ of the mitral annular velocity and GLS were decreased in asymptomatic carotid stenosis patients (p < 0.05), however, the LVEF was well preserved. Based on a predefined cutoff for subclinical LV systolic dysfunction that was defined at a GLS <  − 18%, this dysfunction was detected in 22 patients with carotid stenosis (44%) and in 10 patients in the control group (22%) (p < 0.05). The GLS was negatively correlated with the levels of low-density lipoprotein cholesterol (r =  − 0.356, p < 0.05) and triglyceride (r =  − 0.396, p < 0.05). In conclusion, LV diastolic and systolic functioning were significantly decreased in patients with asymptomatic carotid stenosis, and dyslipidemia likely contributed to the subclinical LV dysfunction in these patients. Our findings indicated the importance of detecting LV subclinical dysfunction and early intervention in this patient population.