Search Results (384)

Background and Objectives: Type 2 diabetes mellitus (T2DM) is associated with subclinical cardiovascular changes, such as increased arterial stiffness and myocardial dysfunction. Vitamin D deficiency has been recognized as a potential contributing factor to vascular disease; however, its impact on early cardiac changes associated with T2DM remains poorly understood. Our aim was to evaluate the association between serum levels of 25-hydroxyvitamin D3 [25(OH)D3], arterial stiffness, and left ventricular global longitudinal strain (LV GLS) in patients with T2DM who do not have a clinically evident cardiovascular disease. Material and methods: This cross-sectional study evaluated the carotid intima–media thickness (IMT), aortic pulse wave velocity (PWVao), LV GLS, and serum 25(OH)D3 levels in patients diagnosed with T2DM (n = 65) compared to healthy control subjects (n = 55). Independent predictors of arterial stiffness were identified by a multivariate logistic regression analysis. Results: Patients with T2DM showed a significant increase in IMT and PWVao, a reduction in LV GLS, and low levels of 25(OH)D3 compared to subjects in the control group (all p < 0.05). Both vitamin D deficiency and T2DM were found to be independently associated with an increased arterial stiffness, with odds ratios of 2.4 and 4.8, respectively. A significant inverse relationship was identified between 25(OH)D3 levels and markers of arterial stiffness, as well as LV GLS, suggesting a possible association between the vitamin D status and the early onset of cardiovascular dysfunction. Conclusions: Patients with T2DM show early signs of heart and blood vessel problems, even with an ejection fraction that remains within normal limits. There is a significant correlation between vitamin D deficiency and increased arterial stiffness, along with impaired LV GLS, indicating its possible involvement in cardiovascular complications associated with diabetes. These findings support the utility of integrating vascular, myocardial, and vitamin D assessments in early cardiovascular risk stratification for T2DM patients. Full article

Abnormalities in plasma lipoproteins observed in patients with diabetes promote atherosclerosis. However, the association between various lipid species and classes and atherosclerosis remains unclear. Here, we aimed to identify the plasma lipid characteristics associated with atherosclerosis progression in patients with diabetes. We performed semi-targeted lipidomic analysis of fasting plasma samples using supercritical fluid chromatography coupled with mass spectrometry in two independent patient groups with type 2 diabetes (n = 223 and 31) and evaluated cross-sectional associations between plasma lipids and carotid intima-media thickness (CIMT). Ten plasma lipid species, including eight diacylglycerols (DGs), and total DG levels were significantly associated with CIMT in both groups. Patients of the former group were partly observed for 5 years, and we investigated associations between DGs and CIMT progression in these patients (n = 101). As a result, 22 DGs among the 26 identified DGs and total DG (β = 0.398, p < 0.001) were significantly associated with the annual change in CIMT. Furthermore, plasma DG levels improved the predictive ability for CIMT progression, with an adjusted R-squared increase of 0.105 [95% confidence interval: 0.010, 0.232] in the models. Plasma DGs are associated with CIMT progression in patients with type 2 diabetes. Measurement of total plasma DG levels may be beneficial in assessing the risk of atherosclerosis progression. Full article

Background: While carotid pathologies are well-established risk factors for stroke, their specific effects on outcomes following stroke that cannot be classified as atherosclerotic remain unclear. In this study, we aimed to determine whether carotid pathologies are associated with functional dependence (FD) 3 months after small vessel occlusion (SVO) stroke. Methods: This retrospective study included patients with a first-ever SVO stroke admitted to a single cerebrovascular-specialty hospital between October 2021 and March 2024. Standardized ultrasound criteria were used to grade the carotid plaques. The modified Rankin scale (mRS) was used to assess functional outcomes at 3 months. Logistic regression analysis was performed to identify FD predictors (mRS of ≥2). Results: Of the 372 included patients, 276 achieved functional independence and 96 experienced FD at 3 months. Univariable analysis revealed an association between carotid plaque grade III and FD (odds ratio [OR], 2.46; 95% confidence interval [CI], 1.05–6.51; p = 0.049). However, this association was not significant in the multivariable model. Overall, age (adjusted OR, 1.07; 95% CI 1.03–1.10, p < 0.001), NIHSS at initial presentation (adjusted OR, 1.84; 95% CI, 1.55–2.18; p < 0.001), and diabetes (adjusted OR, 2.84; 95% CI, 1.37–5.92; p = 0.005) were independently associated with FD 3 months after SVO stroke. Conclusions: Carotid plaque severity was not independently associated with functional outcomes 3 months after SVO stroke. Age, NIHSS at initial presentation, and diabetes were identified as independent FD predictors. Future in-depth studies are warranted to confirm the complex interplay of factors influencing functional outcomes in patients with SVO stroke and carotid pathologies simultaneously. Full article

Background/Objectives: This study was conducted to analyze the associations between vascular endothelial growth factor (VEGF) serum concentrations and immunological biomarkers, inflammatory parameters, classical atherosclerosis risk factors, and cardiovascular manifestations in systemic lupus erythematosus (SLE) patients. Methods: The project included 83 individuals suffering from SLE, with 20 healthy individuals as controls. The serum levels of VEGF were determined through the ELISA method using R&D Systems tests. Laboratory markers, autoantibody profiles, traditional atherosclerotic risk factors, and organ manifestations were evaluated. Atherosclerotic changes were determined based on several indices including carotid intima-media thickness, ankle-brachial index and high resistance index assessments. Results: The reference range of serum VEGF concentrations was established based on the 25th and 75th percentiles obtained in the controls. High VEGF levels were significantly correlated with the presence of selected anti-phospholipid antibodies such as anti-prothrombin (OR = 10.7; 95%CI: 2.1–53.4) and anti-beta2 glycoprotein I (OR = 3.5; 95%CI: 1.1–10.8), as well as cardiac disorders (OR = 8.0; 95%CI: 1.6–39.5). On the other hand, low concentrations of VEGF were significantly related to lower frequencies of anti-double-stranded DNA antibodies (OR = 0.31; 95%CI: 0.11–0.91) and anti-endothelial cell antibodies (OR = 0.30; 95%CI: 0.11–0.85). Patients with low VEGF levels showed significantly reduced risks of atherosclerotic lesions (OR = 0.24; 95%CI: 0.04–0.99) and vasculitis development (OR = 0.17; 95%CI = 0.03–0.91). Conclusions: In conclusion, VEGF’s pathogenetic role in SLE and SLE-related atherothrombosis is manifested in close correlation with aPLs which may enhance their direct impact on endothelium. High VEGF levels are helpful for identifying cardiovascular risk in patients, while low concentrations indicate lower disease activity, as well as a lower risk of organ involvement. Full article

Endothelial dysfunction appears early in type 1 diabetes (T1D). The detection of the first vascular disturbances in T1D patients is crucial, and the introduction of novel techniques, such as flow-mediated skin fluorescence (FMSF) and adaptive optics retinal camera (Rtx) imaging, gives hope for better detection and prevention of angiopathies in the future. In this study, we aimed to investigate microcirculation disturbances in pediatric patients with T1D with the use of FMSF and Rtx imaging. This research focused especially on the relationship between microvascular parameters obtained in FMSF and Rtx measurements, and the glycemic control evaluated in continuous glucose monitoring (CGM) reports. We observed significantly increased wall thickness (WT) and wall-to-lumen ratio (WLR) values in T1D patients in comparison to the control group. Although we did not observe significant differences between the T1D and control groups in the FMSF results, a trend toward significance between the time in range (TIR) and hyperemic response (HR_max) and an interesting correlation between the carotid intima-media thickness (cIMT_max) and HR_max. were observed. In conclusion, FMSF and Rtx measurments are innovative techniques enabling the detection of early microvascular disturbances. Full article

Background/Objectives: Acromegaly is associated with multiple metabolic comorbidities, but the relationship between disease activity and metabolic dysfunction-associated steatotic liver disease (MASLD) or cardiovascular risk remains unclear. This study aimed to assess the prevalence and severity of MASLD and liver fibrosis in patients with acromegaly relative to healthy controls and explore whether disease activity influences these parameters. We also evaluated cardiovascular risk indicators in acromegaly patients. Methods: A retrospective case-control study was conducted between 2000 and 2022, involving 58 acromegaly patients and 58 healthy controls. Patients were classified as active or in biochemical remission. MASLD was assessed using the fibrosis-4 (FIB-4) index, MASLD fibrosis score, body mass index, diabetes (BARD) score, the aspartate aminotransferase-to-platelet index (APRI), and the aspartate aminotransferase-to-alanine aminotransferase ratio. Cardiovascular evaluation included pulse wave velocity (PWV) and carotid intima–media thickness (CIMT). Results: The median age of the acromegaly group was 47.5 (39–57) years, compared to 42 (40–48) years in the control group (p = 0.041). APRI (p < 0.001), FIB-4 (p < 0.001), MASLD fibrosis score (p < 0.001), and BARD score (p < 0.001) were significantly higher in the acromegaly group. The prevalence of hepatic steatosis was also higher in the acromegaly group (p < 0.001). Diastolic blood pressure (p = 0.015) and PWV (p = 0.012) were significantly higher in the acromegaly group. Conclusions: Acromegaly patients have an increased risk of MASLD and fibrosis, but this risk is unassociated with disease activity. Similarly, cardiovascular risk parameters remain elevated regardless of disease activity. These findings suggest that the systemic effects of acromegaly may persist despite biochemical control. Full article

Background: Over the past decade, few echocardiographic investigations have assessed myocardial strain parameters in women with a history of hypertensive disorders of pregnancy (HDP), and their findings have been inconsistent. Moreover, no study has comprehensively evaluated deformation indices of all biventricular and biatrial chambers in women post-HDP. This study aimed to examine the structural and functional myocardial properties of all cardiac chambers in a cohort of women with prior HDP at six years after delivery. Methods: We analyzed a consecutive cohort of women with previous HDP and compared them with a control group of normotensive healthy women matched for age and body mass index (BMI). Both groups underwent standard transthoracic echocardiography (TTE) supplemented by a detailed speckle tracking echocardiography (STE) evaluation of biventricular and biatrial myocardial deformation, along with carotid ultrasound, at six years postpartum. The primary endpoint was subclinical myocardial dysfunction, defined by impaired left ventricular global longitudinal strain (LV-GLS < 20%), while the secondary endpoint was early carotid atherosclerosis, defined by common carotid artery intima-media thickness (CCA-IMT) ≥ 0.7 mm. Results: The study included 31 women with previous HDP (mean age 42.3 ± 5.9 years) and 30 matched controls without HDP history (mean age 40.8 ± 5.0 years). The average follow-up duration was 6.1 ± 1.3 years postpartum. Despite preserved and comparable systolic function on conventional TTE, most myocardial strain and strain rate measures in both ventricles and atria were significantly reduced in the HDP group compared to controls. Subclinical myocardial dysfunction was detected in 58.1% of women with prior HDP, and 67.7% exhibited increased CCA-IMT (≥0.7 mm). A history of pre-eclampsia (PE) was independently associated with subclinical myocardial dysfunction (HR 4.01, 95% CI 1.05–15.3, p = 0.03). Both third-trimester BMI (HR 1.21, 95% CI 1.07–1.38, p = 0.003) and PE (HR 6.38, 95% CI 1.50–27.2, p = 0.01) independently predicted early carotid atherosclerosis. Notably, a third-trimester BMI above 27 kg/m² showed optimal sensitivity and specificity for identifying the secondary outcome. Conclusions: A history of PE is independently associated with a higher risk of subclinical myocardial dysfunction and early carotid atherosclerosis at six years postpartum. Full article

Background/Objectives: Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) exhibit increased cardiovascular risk, partly attributed to persistent systemic inflammation. Janus kinase inhibitors (JAKi) effectively reduce inflammation, but their impact on cardiovascular risk remains unclear. This pilot study aimed to evaluate the effect of JAKi therapy on systemic inflammation and lipid markers, correlate traditional cardiovascular risk factors with biological parameters, and quantify subclinical atherosclerosis progression. Methods: We conducted a prospective, single-center study including 48 patients receiving JAKi. Clinical, inflammatory, lipid, and vascular parameters were assessed at baseline (T0) and after 12 months (T1). Primary endpoints included changes in carotid intima-media thickness (cIMT), ankle-brachial index (ABI), and carotid plaque presence. Results: Mean cIMT significantly decreased from 0.29 mm to 0.125 mm (p = 0.019), while ABI improved modestly, but not significantly (0.125 to 0.04, p = 0.103). Carotid plaque prevalence increased slightly from 39.6% to 47.9%, p = 0.159. C-reactive protein (CRP) levels declined significantly, while interleukin (IL)-1β levels increased. Lipoprotein(a) [Lp(a)] levels decreased significantly (mean reduction −7.96 mmol/L, p = 0.001). Multivariate regression identified Lp(a) as an independent predictor of carotid plaque at both T0 (p = 0.011) and T1 (p = 0.005). Baseline ABI was a significant predictor of acute cardiovascular events [hazard ratio (HR): 4.614, 95% CI: 1.034–20.596, p = 0.045]. Conclusions: JAKi therapy significantly reduced systemic inflammation and cIMT in patients with autoimmune rheumatic diseases, suggesting a potential benefit in attenuating early vascular changes. However, residual cardiovascular risk remains in patients with low ABI and elevated Lp(a), warranting close monitoring. Full article

Atherosclerosis remains a leading cause of mortality globally, and this is worse in people living with HIV (PLHIV). While the administration of antiretroviral therapy (ART) in this population has significant benefits, it is essential to acknowledge that it also has some undesired effects. This study investigated the impact of ART on carotid intima-media thickness (CIMT) in PLHIV as a marker of early atherosclerosis. A literature search was conducted on the PubMed, Scopus, and EBSCOhost databases from 1 January 1987 to 30 May 2025. The methodological quality of the studies was assessed using the Newcastle–Ottawa scale. Data were analyzed using a meta-analysis web tool and reported as the mean difference (MD) and 95% confidence intervals (CIs). Twenty-seven studies, which included 3250 PLHIV on ART and 1542 who were ART-naive, were relevant. The mean age was 41.26 in ART and 39.91 years. The results showed a higher CIMT in PLHIV on ART compared to the ART-naive group, MD = 0.03 mm, 95% CI (0.02 mm to 0.04 mm), p < 0.0001; I² = 96.9%. Subgroup analysis showed that the inclusion of studies conducted on male participants only, those with a sample size of one hundred, and those with a moderate risk of bias contributed to heterogeneity. The results suggest there is an increased risk of atherosclerosis in PLHIV on ART. Full article

Background: There is insufficient data in the literature on the relationship between carotid intima–media thickness (cIMT) measured in non-ST segment elevation myocardial infarction (NSTEMI) and cardiovascular (CV) mortality. Therefore, we aimed to determine the effect of cIMT value on long-term mortality in patients with NSTEMI. Methods: This retrospective cohort study included 279 patients with NSTEMI. In addition to clinical, demographic, laboratory, and angiographic investigations, cIMT, femoral IMT (fIMT), and aortic IMT (aIMT) were measured by B-mode ultrasonography. All patients received follow-up evaluation for CV mortality. The patients were grouped as with and without mortality. Results: Patients with NSTEMI received follow-up evaluations for 7.51 ± 0.85 years and 77 (27.6%) patients had mortality. Age, creatinine, blood urea nitrogen, cIMT, aIMT, fIMT, and SYNTAX score values were significantly higher in patients with mortality compared to patients without mortality. Hemoglobin, total cholesterol, LDL cholesterol, triglyceride levels, and left ventricular ejection fraction were significantly lower in patients with mortality compared to patients without mortality. In multivariate analysis, cIMT, age, and creatinine level were found to be independent predictors of mortality. Among these parameters, an increase in age (each year), carotid IMT (each 0.1 mm), and serum creatinine (each 0.1 mg/L) levels predicted an increase in mortality by 8%, 46.5%, and 12.6%, respectively. In ROC analysis, age, cIMT, and creatinine level were found to determine the development of mortality due to NSTEMI with acceptable sensitivity and specificity when an age of 65 years, 0.80 mm, and 0.90 mg/L were taken as cut-off values, respectively. Discussion: In patients with NSTEMI, cIMT measurement is independently associated with the development of long-term mortality. Full article

Background/Objectives:Arterial hypertension, increased carotid intima-media thickness (cIMT), and arterial stiffness (AS) are recognized predictors of cardiovascular disease (CVD). Emerging evidence suggests that vascular remodeling may precede the full development of hypertension. Furthermore, body mass index (BMI), fat mass percentage (FM%), and visceral adipose tissue (VAT), are significant risk factors for cardiovascular events. Conversely, adherence to the Mediterranean diet is associated with reduced cardiovascular risk due to its beneficial effects on lipid metabolism, inflammation, and vascular health. Methods: This observational study explored the association between nutritional care and cardiovascular risk in 55 Italian adults (27 women, 28 men) consecutively evaluated at the Section of Clinical Nutrition and Nutrigenomics, University of Rome “Tor Vergata”, in 2024. Nutritional and vascular assessments, including BMI, waist-to-hip ratio (WHR), BIA, DXA, lab tests, blood pressure (BP), pulse wave velocity (PWV), and cIMT, were recorded. Spearman’s rank correlation coefficient was used to evaluate the relationship between vascular and nutritional parameters. Wilcoxon rank sum test; Fisher’s exact test; and Pearson’s Chi-squared test were performed for statistical analysis. Participants were divided into two groups based on cIMT > 0.90 mm and ≤0.90 mm. Results: Significant correlations emerged between higher MEDAS scores and BMI (r = −0.53, p < 0.01), FM% (r = −0.49, p < 0.01), VAT (r = −0.63, p < 0.01), and cIMT (r = −0.88, p < 0.01). Higher WHR and VAT were associated with increased brachial and central BP and PWV. Notable dietary differences were significantly higher between cIMT groups. Total cholesterol/C-HDL, C-LDL/C-HDL, the Atherogenic Index of Plasma, and the HOMA Index differed significantly between groups. Significant differences were also observed in the left ventricular diastolic function (p = 0.04), LVM/BSA, and LVM/h^2.7 in individuals with subclinical atherosclerosis (p < 0.05). Conclusions: These innovative findings underline the importance of multidisciplinary approaches to prevent CVD and suggest long-term benefits of Mediterranean diet adherence on vascular health. Full article

Background/Objectives: Estrogen deficiency is strongly related to osteoporosis, but its role in the development of atherosclerotic cardiovascular disease (CVD), particularly in postmenopausal women, is unclear. The aim of this study was to assess the relationship between osteopenia and subclinical atherosclerosis in asymptomatic non-diabetic postmenopausal women. Methods: This prospective study included 117 consecutive postmenopausal women (mean age 59 ± 7 years) referred from the outpatient Rheumatology Clinic of the University Clinical Centre of Kosovo, recruited between September 2021 and December 2022. Clinical, biochemical, bone mineral density (BMD), carotid ultrasound and coronary CT angiography data were analyzed. Subclinical atherosclerosis was diagnosed as the presence of carotid plaques and/or increased intima-media thickness (CIMT) > 1.0 mm. Results: Of the 117 studied women, 83 (71%) had osteopenia or osteoporosis (T-score < −1 SD), who had higher prevalence of carotid artery plaques (27.7 vs. 8.8%, p = 0.019), compared to those with normal BMD. They were, also, older (p < 0.001), had a longer duration of menopause (p = 0.004) and higher CAC scores (p < 0.019), compared to those without plaques. In multivariate analysis [odds ratio 95% confidence interval], age [1.244 (1.052–1.470), p = 0.001], osteoporosis [0.197 (0.048–0.806), p = 0.024] and CAC score > 10 HU [0.174 (0.058–0.806), p = 0.006] were independently associated with the presence of carotid plaques. Conclusions: Reduced BMD is highly prevalent in asymptomatic non-diabetic postmenopausal women and is associated with a high prevalence of subclinical carotid atherosclerosis. Age, osteoporosis and CAC score > 10 HU were independently associated with atherosclerotic carotid plaque formation. These findings highlight the potential pathophysiological link between osteoporosis and subclinical atherosclerosis. Full article

Objective: 3-Nitrotyrosine (3-NT) is a byproduct of tyrosine nitration, mediated by reactive nitrogen species such as peroxynitrite and nitrogen dioxide. It serves as a marker of cellular damage, inflammation, and nitric oxide activity. Rheumatoid arthritis (RA) is a complex autoimmune disease characterized by systemic involvement and increased oxidative stress. In RA patients, cardiovascular disease has emerged as the leading cause of mortality. This study aimed to investigate the relationship between serum 3-NT levels and various disease characteristics in RA patients, with a particular focus on cardiovascular comorbidities. Methods: A total of 168 RA patients were recruited. They underwent comprehensive evaluations, including disease-related characteristics and disease activity indices. Furthermore, a comprehensive lipid panel, measures of insulin resistance, metabolic syndrome criteria, and carotid ultrasound to evaluate intima–media thickness and the presence of carotid plaques were conducted. 3-NT serum levels were measured. A multivariable linear regression analysis was performed to examine the associations between the disease characteristics and 3-NT. Results: After multivariable analysis, C-reactive protein was independently associated with higher serum levels of 3-NT. In contrast, disease characteristics and Disease Activity Score 28-joint count (DAS28) calculated using C-reactive protein or erythrocyte sedimentation rate, showed no significant association with 3-NT levels. Likewise, cardiovascular comorbidities, including lipid profiles, insulin resistance indices, metabolic syndrome, and markers of subclinical atherosclerosis did not demonstrate any significant relationship with 3-NT levels. Conclusions: While 3-NT levels are influenced by inflammation, they do not appear to be strongly associated with disease characteristics, cardiovascular risk, or disease-modifying anti-rheumatic drugs in RA patients. This emphasizes the complexity of oxidative stress in RA. Full article

Diabetic kidney disease (DKD) displays a high prevalence of cardiovascular and cerebrovascular disease. Both the kidney and the brain share common pathogenic mechanisms, such as inflammation, endothelial dysfunction, oxidative stress, and mitochondrial dysfunction. The aim of this study was to establish a potential association of cerebral vessel remodeling and its related functional impairment with biomarkers of inflammation, oxidative stress, and mitochondrial dysfunction in the early stages of DKD in type 2 diabetes mellitus (DM) patients. A cohort of 184 patients and 39 healthy controls was assessed concerning serum and urinary stromal cell-derived factor-1 (SDF-1), P-selectin, advanced oxidation protein products (AOPPs), urinary synaptopodin, podocalyxin, kidney injury molecule-1 (KIM-1), and N-acetyl-β-(D)-glucosaminidase (NAG). The quantification of the mitochondrial DNA copy number (mtDNA-CN) and nuclear DNA (nDNA) in urine and peripheral blood was conducted using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Using TaqMan tests, the beta-2 microglobulin nuclear gene (B2M) and the cytochrome b (CYTB) gene, which encodes subunit 2 of NADH dehydrogenase (ND2), were evaluated. The MtDNA-CN is the ratio of mitochondrial DNA to nuclear DNA copies, ascertained through the examination of the CYTB/B2M and ND2/B2M ratios. The intima-media thickness (IMT) measurements of the common carotid arteries (CCAs), along with the pulsatility index (PI) and resistivity index (RI) of the internal carotid arteries (ICAs) and middle cerebral arteries (MCAs), were obtained through cerebral Doppler ultrasonography (US). Additionally, the breath-holding index (BHI) was also measured by cerebral Doppler US. PI-ICAs, PI-MCAs, CCAs-IMT, RI-MCAs, and RI-ICAs demonstrated direct relationships with SDF-1, P-selectin, AOPPs, urine mtDNA, podocalyxin, synaptopodin, NAG, and KIM-1 while showing indirect correlations with serum mtDNA and the eGFR. In contrast, the BHI had negative correlations with SDF-1, P-selectin, AOPPs, urine mtDNA, synaptopodin, podocalyxin, KIM-1, and NAG while showing direct associations with serum mtDNA and the eGFR. In conclusion, a causative association exists among SDF-1, P-selectin, and AOPPs, as well as mitochondrial dysfunction, in early diabetic kidney disease (DKD) and significant cerebrovascular alterations in patients with type 2 diabetes mellitus and normoalbuminuric DKD, with no neurological symptoms. Full article

Background: Calmodulin is a calcium-signaling protein implicated in cardiac remodeling and could be released extracellularly. It was previously identified as differentially expressed in hypertensive pediatric chronic kidney disease (CKD). This study assessed plasma calmodulin as a cardiovascular disease (CVD) biomarker in pediatric CKD and compared it with traditional risk markers. Methods: We conducted a cross-sectional study of 81 children with CKD aged 3–18 years. All underwent clinical assessments and echocardiography; 44 had carotid ultrasound, and 38 completed ambulatory blood pressure monitoring (ABPM). Results: Most participants had preserved renal function (median eGFR, 104.4 mL/min/1.73 m²). Plasma calmodulin levels were significantly associated with early markers of CVD, including interventricular septal thickness, left ventricular mass, carotid intima–media thickness, and ABPM systolic measures (all r > 0.2; p < 0.05). In multivariable analysis, only calmodulin and office systolic blood pressure (BP) independently predicted abnormal BP profiles. Conclusions: Plasma calmodulin may serve as a sensitive, though non-specific, early CVD biomarker in pediatric CKD and could complement conventional screening tools. Full article