{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T17:54:56Z","timestamp":1781891696101,"version":"3.54.5"},"reference-count":51,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Noncommunicable Chronic Diseases\u2013National Science and Technology","award":["2024ZD0523200"],"award-info":[{"award-number":["2024ZD0523200"]}]},{"DOI":"10.13039\/501100008048","name":"Nanjing University","doi-asserted-by":"publisher","award":["14380546"],"award-info":[{"award-number":["14380546"]}],"id":[{"id":"10.13039\/501100008048","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Nanjing Health Science and Technology Development","award":["ZKX22027"],"award-info":[{"award-number":["ZKX22027"]}]},{"name":"Drum Tower Hospital"},{"name":"Medical School of Nanjing University","award":["2025-LCYJ-MS-06"],"award-info":[{"award-number":["2025-LCYJ-MS-06"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate the role of cardiac autonomic neuropathy (CAN) in the development and progression of cardiovascular\u2013kidney\u2013metabolic (CKM) syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A three-stage analytical framework was applied. Cross-sectional associations between CAN (assessed by cardiovascular autonomic reflex tests) and CKM stages were examined in a discovery cohort and validated in the UK Biobank cohort. Longitudinal analyses evaluated the association between CAN and incident CKM syndrome in the UK Biobank. Multi-state models were used to assess the influence of CAN on CKM progression. The prevalence of CAN increased progressively across CKM stages (P for trend &amp;lt; 0.001). After adjustment for confounders, CAN was independently associated with advanced CKM stages in the discovery cohort [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.14\u20132.60] and validated in the UK Biobank cohort (OR 1.20, 95% CI 1.13\u20131.27). Prospectively, CAN was associated with a higher incidence of CKM syndrome (HR 1.24, 95% CI 1.18\u20131.31) and earlier occurrence of its individual components, with coronary heart disease and diabetes occurring 4.0 and 3.1 years earlier, respectively. Multi-state analyses further showed that individuals with CAN had 34% and 39% higher risks of transition from stages 0\u20131 to stage 2 and from stage 2 to stage 4, respectively. These associations were particularly pronounced among individuals with excess adiposity, highlighting a potentially vulnerable subgroup for targeted intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CAN was associated with the development and progression of CKM syndrome and may have potential utility in CKM risk assessment and early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag312","type":"journal-article","created":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T11:32:31Z","timestamp":1780831951000},"source":"Crossref","is-referenced-by-count":0,"title":["Cardiac autonomic neuropathy is associated with the incidence and progression of cardiovascular\u2013kidney\u2013metabolic syndrome"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7128-795X","authenticated-orcid":false,"given":"Tongyue","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College , No. 321, Zhongshan Road, Nanjing 210008 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University , No. 321, Zhongshan Road, Nanjing 210008 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University , No. 321, Zhongshan Road, Nanjing 210008 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanrui","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University , No. 321, Zhongshan Road, Nanjing 210008 ,","place":["China"]},{"name":"Department of Endocrinology, Nanjing Drum Tower Hospital, School of Life Sciences, Nanjing University , No. 22 Hankou Road, Gulou District, Nanjing 210093 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangguo","family":"Cong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, The Affiliated Suzhou Hospital of Nanjing Medical University , No. 26 Daoqian Street, Gusu District, Suzhou, Jiangsu 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Affiliated Hospital of Medical School, Nanjing University , No. 321, Zhongshan Road, Nanjing 210008 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianwei","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University , No. 321, Zhongshan Road, Nanjing 210008 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3914-7854","authenticated-orcid":false,"given":"Yan","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Chinese Academy of Medical Science & Peking Union Medical College , No. 321, Zhongshan Road, Nanjing 210008 ,","place":["China"]},{"name":"Department of Endocrinology, Endocrine and Metabolic Disease 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