{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:01:40Z","timestamp":1790301700668,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007771","name":"Medical University of Silesia in Katowice","doi-asserted-by":"publisher","award":["BNW\u20102\u2010046\/N\/4\/K"],"award-info":[{"award-number":["BNW\u20102\u2010046\/N\/4\/K"]}],"id":[{"id":"10.13039\/100007771","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Diabetes is characterized by clinical heterogeneity. This study aimed to identify different clinical phenotypes of real\u2010world people with diabetes and to assess their associations with major adverse cardiovascular events (MACEs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From a prospective Polish registry of people with diabetes, hierarchical cluster analysis was performed based on 19 variables, including co\u2010morbidities and cardiovascular (CV) risk factors. The primary outcome was the risk of MACEs (CV death, acute coronary syndrome and myocardial revascularizations, ischaemic stroke, new onset heart failure, and hospitalization for CV reasons). Secondary exploratory outcomes were each MACE component and all\u2010cause death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On 2109 participants (median age 60\u2009years, interquartile range [IQR] 45\u201369, 51.3% men) included, three different phenotypes were identified: (i) cluster 1 (27.8%) \u2013 young with type 1 diabetes; (ii) cluster 2 (42.0%) \u2013 elderly with type 2 diabetes and high complexity; (iii) cluster 3 (30.2%) \u2013 middle\u2010aged with type 2 diabetes and cardiometabolic risk factors.<\/jats:p>\n                    <jats:p>Compared to cluster 1, the risk of primary outcome was higher for clusters 2 and 3 (adjusted hazard ratio [aHR] 2.93, 95% CI 1.60\u20135.36, and aHR 1.85 95% CI 1.07\u20133.20, respectively). Using cluster 3 as the reference, cluster 1 was associated with a lower risk (aHR 0.54, 95% CI 0.31\u20130.94), and cluster 2 with a higher risk (aHR 1.58, 95% CI 1.08\u20132.33).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>People with diabetes aggregate into different clinical phenotypes, each with different risks of MACEs. Integrated approaches tailored to these diverse clinical profiles are needed to improve outcomes in this heterogeneous and multifaceted disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70136","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T08:43:36Z","timestamp":1758185016000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical risk phenotypes in diabetes and their associations with adverse cardiovascular events: A report from the Silesia Diabetes\u2010Heart Project"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7290-5361","authenticated-orcid":false,"given":"Marta","family":"Mantovani","sequence":"first","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena  Modena Italy"},{"name":"Clinical and Experimental Medicine PhD Program University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Kwiendacz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof","family":"Irlik","sequence":"additional","affiliation":[{"name":"Doctoral School, Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Bucci","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirela","family":"Hendel","sequence":"additional","affiliation":[{"name":"Student\u2019s Scientific Association at the Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven H. M.","family":"Lam","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bi","family":"Huang","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Cardiology The First Affiliated Hospital of Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Szromek\u2010Bia\u0142ek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Niezgoda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uazman","family":"Alam","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Diabetes &amp; Endocrinology Research and Pain Research Institute, Institute of Life Course and Medical Sciences University of Liverpool and Liverpool University Hospital National Health Service Foundation Trust  Liverpool UK"},{"name":"Centre for Biomechanics and Rehabilitation Technologies Staffordshire University  Stoke\u2010on\u2010Trent UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Boriani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia, Policlinico di Modena  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janusz","family":"Gumprecht","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Danish Center for Health Services Research Department of Clinical Medicine, Aalborg University  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Nabrdalik","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital  Liverpool UK"},{"name":"Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze Medical University of Silesia  Katowice Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v6.i13.1246"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-022-01516-6"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62219-9"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-017-0621-2"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2022.09.008"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcad219"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acvd.2023.06.001"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0290553"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17249523"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2023.101694"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000001940"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc25-S010"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209707"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2021.07.001"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-03032-4"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci21-0043"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309303291401"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.60426"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad226"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2022.11.004"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afx201"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-2623"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-024-01634-0"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(22)00003-1"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.15184"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.119.315896"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.0219"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13098-019-0482-2"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S002"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13300-024-01615-5"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/9985836"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-024-01214-6"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(19)30187-1"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.2337\/db10-0862"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.29.04.06.dc05-1433"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408214"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-022-02526-7"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euac082"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0118-8"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000691"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70136","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dme.70136","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.70136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:34:21Z","timestamp":1773012861000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.70136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":40,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/dme.70136"],"URL":"https:\/\/doi.org\/10.1111\/dme.70136","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]},"assertion":[{"value":"2024-09-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70136"}}