{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:57:46Z","timestamp":1789181866323,"version":"build-2803163510"},"reference-count":91,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health","award":["364\/2021\/DA"],"award-info":[{"award-number":["364\/2021\/DA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Recent progress in laboratory medicine provides powerful tools for the detailed evaluation of cardiovascular risk in military populations. This study aimed to characterize cardiometabolic biomarker profiles across four Polish military groups through chemometric analysis. The study included 392 participants (336 men, 56 women, aged 19\u201356 years). In total, 23 serum biomarkers from lipid, metabolic, hepatic, hormonal, and bone axes, and lactate dehydrogenase (LDH) were analyzed. Random forest (RF) modeling and effect-size profiling identified group-specific signatures. Group 4 (exposed to extreme acceleration forces and ionizing radiation) exhibited a systemic stress and metabolic-load profile with higher N-terminal pro-B-type natriuretic peptide (NT-proBNP, 36.7 \u00b1 48.2 pg\/mL) and calcium (Ca, 10.4 \u00b1 0.88 mg\/dL), and lower parathyroid hormone (PTH, 15.4 \u00b1 10.1 pg\/mL) and C-terminal telopeptide of type I collagen (\u03b2-CTX, 0.22 \u00b1 0.19 ng\/mL). Group 2 (exposed to fuels and exhaust gases) and group 3 (exposed to vibration, noise, ionizing radiation) showed an atherogenic\u2013hepatometabolic axis with elevated apolipoprotein B (apoB, 1.04 \u00b1 0.31; 0.97 \u00b1 0.29 g\/L), non-high-density lipoprotein cholesterol (N-HDL, 151.0 \u00b1 46.7; 147.0 \u00b1 41.4 mg\/dL), and alanine aminotransferase (ALT). Group 1 (exposed to a biological hazard) displayed higher glucose (Glu, 96.0 \u00b1 25.6 mg\/dL) and triglycerides (TG, 151.0 \u00b1 113.0 mg\/dL) with lower magnesium (Mg, 2.03 \u00b1 0.27 mg\/dL). RF modeling confirmed these constellations. This study was exploratory in nature, providing a foundation for future longitudinal research. These findings provide a rationale for tailored cardiovascular surveillance, although causal inference is limited by the cross-sectional design.<\/jats:p>","DOI":"10.3390\/ijms262211109","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T14:04:07Z","timestamp":1763388247000},"page":"11109","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiometabolic Biomarkers and Cardiovascular Risk Stratification in Polish Military Personnel: A Chemometric Approach"],"prefix":"10.3390","volume":"26","author":[{"given":"Agata","family":"Pabin","sequence":"first","affiliation":[{"name":"Department of Laboratory Diagnostics, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Bojarczuk","sequence":"additional","affiliation":[{"name":"Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grzegorz","family":"Kade","sequence":"additional","affiliation":[{"name":"Department of Laboratory Diagnostics, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0050-7891","authenticated-orcid":false,"given":"Aleksandra","family":"Garbacz","sequence":"additional","affiliation":[{"name":"Faculty of Animal Genetics and Conservation, Warsaw University of Life Sciences, 02-787 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0636-2961","authenticated-orcid":false,"given":"Katarzyna","family":"Komar","sequence":"additional","affiliation":[{"name":"Department of Laboratory Diagnostics, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3122-3085","authenticated-orcid":false,"given":"Ewelina","family":"Maculewicz","sequence":"additional","affiliation":[{"name":"Department of Laboratory Diagnostics, Military Institute of Aviation Medicine, 01-755 Warsaw, Poland"},{"name":"Faculty of Physical Education, Jozef Pilsudski University of Physical Education in Warsaw, 00-968 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Netala, V.R., Teertam, S.K., Li, H., and Zhang, Z. (2024). A comprehensive review of cardiovascular disease management: Cardiac biomarkers, imaging modalities, pharmacotherapy, surgical interventions, and herbal remedies. Cells, 13.","DOI":"10.3390\/cells13171471"},{"key":"ref_2","unstructured":"World Health Organization (2025, July 18). Cardiovascular diseases (CVDs). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.atherosclerosis.2015.03.021","article-title":"Genetics of cardiovascular disease: Importance of sex and ethnicity","volume":"241","author":"Winham","year":"2017","journal-title":"Atherosclerosis"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Carola, V., Vincenzo, C., Di Vincenzo, G., Morale, C., Cecchi, V., and Nicolais, G. (2024). Psychological risk factors and cardiovascular disease. Front. Psychol., 15.","DOI":"10.3389\/fpsyg.2024.1419731"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1161\/HYPERTENSIONAHA.119.14240","article-title":"High blood pressure and cardiovascular disease","volume":"75","author":"Fuchs","year":"2020","journal-title":"Hypertension"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0140-6736(15)01225-8","article-title":"Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis","volume":"387","author":"Ettehad","year":"2016","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.pop.2012.11.003","article-title":"Hyperlipidemia as a risk factor for cardiovascular disease","volume":"40","author":"Nelson","year":"2013","journal-title":"Prim. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e051121189015","DOI":"10.2174\/1573403X16999201210200342","article-title":"Relationship between hyperlipidemia, cardiovascular disease and stroke: A systematic review","volume":"17","author":"Alloubani","year":"2020","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1038\/s41569-023-00877-z","article-title":"Cardiovascular risk in diabetes mellitus: Epidemiology, assessment and prevention","volume":"20","author":"Wong","year":"2023","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"154838","DOI":"10.1016\/j.metabol.2021.154838","article-title":"Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes","volume":"123","author":"Yun","year":"2021","journal-title":"Metabolism"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1093\/eurjpc\/zwae025","article-title":"Obesity and cardiovascular health","volume":"31","author":"Welsh","year":"2024","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1007\/s11886-023-01975-7","article-title":"Obesity, cardiorespiratory fitness, and cardiovascular disease","volume":"25","author":"Haidar","year":"2023","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Josloff, K., Beiriger, J., Khan, A., Gawel, R.J., Kirby, R.S., Kendrick, A.D., Rao, A.K., Wang, R.X., Schafer, M.M., and Pearce, M.E. (2022). Comprehensive review of cardiovascular disease risk in nonalcoholic fatty liver disease. J. Cardiovasc. Dev. Dis., 9.","DOI":"10.3390\/jcdd9120419"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1038\/s41581-022-00616-6","article-title":"Epidemiology and risk of cardiovascular disease in populations with chronic kidney disease","volume":"18","author":"Matsushita","year":"2022","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1038\/s41569-024-01045-7","article-title":"Autoimmune diseases and atherosclerotic cardiovascular disease","volume":"21","author":"Porsch","year":"2024","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_16","unstructured":"Werfelman, L. (2025, August 01). Linking Age and Fitness to Fly. Available online: https:\/\/flightsafety.org\/asw-article\/linking-age-and-fitness-to-fly\/."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.annepidem.2004.08.002","article-title":"Body mass index and cardiovascular disease in a birth cohort of commuter air carrier and air taxi pilots","volume":"15","author":"Qiang","year":"2005","journal-title":"Ann. Epidemiol."},{"key":"ref_18","first-page":"1117","article-title":"Van. Permanent flying disqualifications of USAF pilots and navigators (1995\u20131999)","volume":"73","author":"McCrary","year":"2002","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_19","first-page":"1023","article-title":"Review of cardiac events in USAF aviators","volume":"67","author":"Osswald","year":"1996","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"622","DOI":"10.3357\/ASEM.2981.2011","article-title":"Metabolic syndrome and carotid artery intima-media thickness in military pilots","volume":"82","author":"Radjen","year":"2011","journal-title":"Aviat. Space Environ. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100040","DOI":"10.1016\/j.reach.2021.100040","article-title":"Cardiovascular screening for pilots, aircrew, and high performance & spaceflight passengers","volume":"21\u201322","author":"Davenport","year":"2021","journal-title":"REACH"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"128","DOI":"10.3357\/AMHP.6557.2025","article-title":"Cardiac causes of disqualification in Portuguese Air Force pilots","volume":"96","author":"Pereira","year":"2025","journal-title":"Aerosp. Med. Hum. Perform."},{"key":"ref_23","first-page":"33","article-title":"Medical causes and diseases leading to early permanent disqualification in IRIAF pilots based on their service categories","volume":"29","author":"Shahali","year":"2021","journal-title":"JMVH"},{"key":"ref_24","first-page":"135","article-title":"Medical disqualification as a barrier to healthcare in military service members","volume":"7","author":"Jones","year":"2024","journal-title":"Clin. Pract. Athl. Train."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Maculewicz, E., Pabin, A., Kowalczuk, K., Dziuda, \u0141., and Bia\u0142ek, A. (2022). Endogenous risk factors of cardiovascular diseases (CVDs) in military professionals with a special emphasis on military pilots. J. Clin. Med., 11.","DOI":"10.3390\/jcm11154314"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Maculewicz, E., Pabin, A., Dziuda, \u0141., Bia\u0142ek, M., and Bia\u0142ek, A. (2023). Selected exogenous (occupational and environmental) risk factors for cardiovascular diseases in military and aviation. J. Clin. Med., 12.","DOI":"10.3390\/jcm12237492"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S2213-8587(15)00081-9","article-title":"A novel risk score for predicting cardiovascular disease risk in national populations: A pooled analysis of prospective cohorts and health examination surveys","volume":"3","author":"Hajifathalian","year":"2015","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1161\/CIRCULATIONAHA.109.852756","article-title":"Cardiovascular risk-estimation systems in primary prevention: Do they differ? Do they make a difference? Can we see the future?","volume":"122","author":"Cooney","year":"2010","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.jacc.2009.07.020","article-title":"Value and limitations of existing scores for the assessment of cardiovascular risk: A review for clinicians","volume":"54","author":"Cooney","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","first-page":"1","article-title":"New biomarkers for cardiovascular disease","volume":"50","author":"Kim","year":"2023","journal-title":"Tex. Heart Inst. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1536\/ihj.24-149","article-title":"Comprehensive assessment of lipid markers in cardiovascular events prediction","volume":"65","author":"Inoue","year":"2024","journal-title":"Int. Heart J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"E1124","DOI":"10.1503\/cmaj.230048","article-title":"Apolipoprotein B in cardiovascular risk assessment","volume":"195","author":"Ahmad","year":"2023","journal-title":"CMAJ"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Amezcua-Castillo, E., Gonz\u00e1lez-Pacheco, H., S\u00e1enz-San Mart\u00edn, A., M\u00e9ndez-Ocampo, P., Gutierrez-Moctezuma, I., Mass\u00f3, F., Sierra-Lara, D., Springall, R., Rodr\u00edguez, E., and Arias-Mendoza, A. (2023). C-reactive protein: The quintessential marker of systemic inflammation in coronary artery disease-advancing toward precision medicine. Biomedicines, 11.","DOI":"10.3390\/biomedicines11092444"},{"key":"ref_34","unstructured":"MedlinePlus (2025, August 22). Homocysteine Test, Available online: https:\/\/medlineplus.gov\/lab-tests\/homocysteine-test\/."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1111\/j.1524-6175.2004.03643.x","article-title":"Relationship of homocysteine with cardiovascular disease and blood pressure","volume":"6","author":"Dinavahi","year":"2004","journal-title":"J. Clin. Hypertens."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Andersen, T., Ueland, T., Aukrust, P., Nilsen, D.W.T., Grundt, H., Staines, H., P\u00f6nitz, V., and Kontny, F. (2023). Procollagen type 1 N-terminal propeptide is associated with adverse outcome in acute chest pain of suspected coronary origin. Front. Cardiovasc. Med., 10, Erratum in: Front. Cardiovasc. Med. 2025, 12, 1650107.","DOI":"10.3389\/fcvm.2023.1191055"},{"key":"ref_37","first-page":"101056","article-title":"Association between total type I collagen N-terminal propeptide and coronary artery disease risk score in the general Japanese population","volume":"41","author":"Kikuchi","year":"2022","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jocd.2019.03.004","article-title":"Consensus statement on the use of bone turnover markers for short-term monitoring of osteoporosis treatment in the Asia-Pacific region","volume":"24","author":"Wu","year":"2021","journal-title":"J. Clin. Densitom."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.cca.2020.12.023","article-title":"Analytical considerations and plans to standardize or harmonize assays for the reference bone turnover markers PINP and \u03b2-CTX in blood","volume":"515","author":"Bhattoa","year":"2021","journal-title":"Clin. Chim. Acta"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1007\/s00198-012-2076-9","article-title":"Association of bone turnover markers with mortality in men referred to coronary angiography","volume":"24","author":"Lerchbaum","year":"2013","journal-title":"Osteoporos. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3016","DOI":"10.3748\/wjg.v30.i24.3016","article-title":"Alanine aminotransferase predicts incident steatotic liver disease of metabolic etiology: Long life to the old biomarker!","volume":"30","author":"Lonardo","year":"2024","journal-title":"World J. Gastroenterol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1016\/S2468-1253(21)00308-3","article-title":"Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: An updated systematic review and meta-analysis","volume":"6","author":"Mantovani","year":"2021","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s12933-025-02764-y","article-title":"Increased prevalence and risk of atherosclerotic cardiovascular disease in individuals with type 1 diabetes and metabolic dysfunction-associated steatotic liver disease","volume":"24","author":"Mertens","year":"2025","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_44","first-page":"243","article-title":"Predictive markers of metabolically healthy obesity in children and adolescents: Can AST\/ALT ratio serve as a simple and reliable diagnostic indicator?","volume":"183","year":"2024","journal-title":"Eur. J. Pediatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"9480228","DOI":"10.1155\/2022\/9480228","article-title":"Association between ALT\/AST and muscle mass in patients with type 2 diabetes mellitus","volume":"2022","author":"Ma","year":"2022","journal-title":"Mediat. Inflamm."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Han, S.K., Seo, M.J., Lee, T., and Kim, M.Y. (2024). Effectiveness of the ALT\/AST ratio for predicting insulin resistance in a Korean population: A large-scale, cross-sectional cohort study. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0303333"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Cheng, X., Liu, L., Tian, Y., and Lin, Y. (2025). Serum lactate dehydrogenase as a prognostic marker for 90-day mortality in connective tissue disease patients receiving glucocorticoids and hospitalized with pneumonia: A cohort study. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-01721-9"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Wu, Y., Lu, C., Pan, N., Zhang, M., An, Y., Xu, M., Zhang, L., Guo, Y., and Tan, L. (2021). Serum lactate dehydrogenase activities as systems biomarkers for 48 types of human diseases. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-92430-6"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2147\/IJGM.S337517","article-title":"Serum level of lactate dehydrogenase is associated with cardiovascular disease risk as determined by the Framingham risk score and arterial stiffness in a health-examined population in China","volume":"15","author":"Zhu","year":"2022","journal-title":"Int. J. Gen. Med."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Li, W., Jiao, Y., Wang, L., Wang, S., Hao, L., Wang, Z., Wang, H., Zhang, B., Ding, G., and Jiang, H. (2022). Association of serum magnesium with insulin resistance and type 2 diabetes among adults in China. Nutrients, 14.","DOI":"10.3390\/nu14091799"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1111\/j.1463-1326.2010.01332.x","article-title":"Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects\u2014A double-blind, placebo-controlled, randomized trial","volume":"13","author":"Mooren","year":"2011","journal-title":"Diabetes Obes. Metab."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1080\/10253890.2019.1581760","article-title":"Cortisol stress reactivity in women, diurnal variations and hormonal contraceptives: Studies from the Family Health Patterns Project","volume":"22","author":"Lovallo","year":"2019","journal-title":"Stress"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Smaliukien\u0117, R., Bekesiene, S., Ma\u017eeikien\u0117, A., Larsson, G., Kar\u010diauskait\u0117, D., Mazgelyt\u0117, E., and Vai\u010daitien\u0117, R. (2022). Hair cortisol, perceived stress, and the effect of group dynamics: A longitudinal study of young men during compulsory military training in Lithuania. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031663"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Hua, Y., Liu, H.L., Sun, J.Y., Kong, X.Q., Sun, W., and Xiong, Y.Q. (2021). Association between serum calcium and the prevalence of hypertension among US adults. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.719165"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.ahj.2013.02.014","article-title":"Parathyroid hormone and cardiovascular disease events: A systematic review and meta-analysis of prospective studies","volume":"165","author":"Reinders","year":"2013","journal-title":"Am. Heart J."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Xuan, Y., Wu, D., Zhang, Q., Yu, Z., Yu, J., and Zhou, D. (2024). Elevated ALT\/AST ratio as a marker for NAFLD risk and severity: Insights from a cross-sectional analysis in the United States. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1457598"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e26693","DOI":"10.1097\/MD.0000000000026693","article-title":"The association between AST\/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension","volume":"100","author":"Liu","year":"2021","journal-title":"Medicine"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Zeng, Y., Zhao, Y., Dai, S., Liu, Y., Zhang, R., Yan, H., Zhao, M., and Wang, Y. (2022). Impact of lactate dehydrogenase on prognosis of patients undergoing cardiac surgery. BMC Cardiovasc. Disord., 22.","DOI":"10.1186\/s12872-022-02848-7"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s00198-025-07422-3","article-title":"Update on the role of bone turnover markers in the diagnosis and management of osteoporosis: A consensus paper from The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), International Osteoporosis Foundation (IOF), and International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)","volume":"36","author":"Bhattoa","year":"2025","journal-title":"Osteoporos. Int."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Ismaiel, A., and Dumitra\u015fcu, D.L. (2019). Cardiovascular risk in fatty liver disease: The liver-heart axis-literature review. Front. Med., 6.","DOI":"10.3389\/fmed.2019.00202"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Behbodikhah, J., Ahmed, S., Elyasi, A., Kasselman, L.J., De Leon, J., Glass, A.D., and Reiss, A.B. (2021). Apolipoprotein B and cardiovascular disease: Biomarker and potential therapeutic target. Metabolites, 11.","DOI":"10.3390\/metabo11100690"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Katsi, V., Argyriou, N., Fragoulis, C., and Tsioufis, K. (2025). The role of non-HDL cholesterol and apolipoprotein B in cardiovascular disease: A comprehensive review. J. Cardiovasc. Dev. Dis., 12.","DOI":"10.3390\/jcdd12070256"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Rosique-Esteban, N., Guasch-Ferr\u00e9, M., Hern\u00e1ndez-Alonso, P., and Salas-Salvad\u00f3, J. (2018). Dietary magnesium and cardiovascular disease: A review with emphasis in epidemiological studies. Nutrients, 10.","DOI":"10.3390\/nu10020168"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2156483","DOI":"10.1155\/2022\/2156483","article-title":"Association of serum homocysteine with cardiovascular and all-cause mortality in adults with diabetes: A prospective cohort study","volume":"2022","author":"Lu","year":"2022","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.4239\/wjd.v6.i10.1152","article-title":"Magnesium and type 2 diabetes","volume":"6","author":"Barbagallo","year":"2015","journal-title":"World J. Diabetes"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Bajic, Z., Sobot, T., Skrbic, R., Stojiljkovic, M.P., Ponorac, N., Matavulj, A., and Djuric, D.M. (2022). Homocysteine, vitamins B6 and folic acid in experimental models of myocardial infarction and heart failure\u2014How strong is that link?. Biomolecules, 12.","DOI":"10.3390\/biom12040536"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e23421","DOI":"10.1002\/jcla.23421","article-title":"Prediction for cardiovascular diseases based on laboratory data: An analysis of random forest model","volume":"34","author":"Su","year":"2020","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"DeGroat, W., Abdelhalim, H., Patel, K., Mendhe, D., Zeeshan, S., and Ahmed, Z. (2024). Discovering biomarkers associated and predicting cardiovascular disease with high accuracy using a novel nexus of machine learning techniques for precision medicine. Sci. Rep., 14.","DOI":"10.1038\/s41598-023-50600-8"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Wallace, M.L., Mentch, L., Wheeler, B.J., Tapia, A.L., Richards, M., Zhou, S., Yi, L., Redline, S., and Buysse, D.J. (2023). Use and misuse of random forest variable importance metrics in medicine: Demonstrations through incident stroke prediction. BMC Med. Res. Methodol., 23.","DOI":"10.1186\/s12874-023-01965-x"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/bs.acc.2024.06.009","article-title":"Cardiac natriuretic peptides","volume":"122","author":"Shalmi","year":"2024","journal-title":"Adv. Clin. Chem."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2541","DOI":"10.1007\/s00198-017-4082-4","article-title":"Use of CTX-I and PINP as bone turnover markers: National Bone Health Alliance recommendations to standardize sample handling and patient preparation to reduce pre-analytical variability","volume":"28","author":"Szulc","year":"2017","journal-title":"Osteoporos. Int."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1016\/j.jhep.2014.12.012","article-title":"NAFLD: A multisystem disease","volume":"62","author":"Byrne","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2917","DOI":"10.1016\/j.febslet.2006.04.028","article-title":"The metabolic syndrome and adipocytokines","volume":"580","author":"Matsuzawa","year":"2006","journal-title":"FEBS Lett."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2410","DOI":"10.1093\/eurheartj\/ehae258","article-title":"Discordance among apoB, non\u2013high-density lipoprotein cholesterol, and triglycerides: Implications for cardiovascular prevention","volume":"45","author":"Sniderman","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_75","unstructured":"Roza, D. (2025, August 25). This is a Sport\u2019: F-16 Pilots Use New Sensors to Max Out Human Performance. Available online: https:\/\/www.airandspaceforces.com\/f-16-pilot-human-performance-sensor\/."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"042044","DOI":"10.1088\/1742-6596\/1073\/4\/042044","article-title":"Relationship of fatigue, physical fitness and cardiovascular endurance to the hypoxic response of military pilots in Indonesia","volume":"1073","author":"Sucipta","year":"2018","journal-title":"J. Phys. Conf. Ser."},{"key":"ref_77","first-page":"357","article-title":"2024 Guidelines of the Polish Society of Laboratory Diagnostics and the Polish Lipid Association on laboratory diagnostics of lipid metabolism disorders","volume":"20","author":"Solnica","year":"2024","journal-title":"Arch. Med. Sci."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"100203","DOI":"10.1016\/j.ajpc.2021.100203","article-title":"Utility of non-HDL-C and apoB targets in the context of new more aggressive lipid guidelines","volume":"7","author":"Quispe","year":"2021","journal-title":"Am. J. Prev. Cardiol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s11886-020-01323-z","article-title":"Non-HDL Cholesterol or apoB: Which to prefer as a target for the prevention of atherosclerotic cardiovascular disease?","volume":"22","author":"Langlois","year":"2020","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1111\/dom.14830","article-title":"Reconsidering the role of glycaemic control in cardiovascular disease risk in type 2 diabetes: A 21st century assessment","volume":"24","author":"Aroda","year":"2022","journal-title":"Diabetes Obes. Metab."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Suwa\u0142a, S., and Junik, R. (2025). Hyperglycemia as the most important risk factor for serum hypomagnesemia in metabolic syndrome. Diabetology, 6.","DOI":"10.3390\/diabetology6080082"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1210\/jc.2018-01656","article-title":"Association between triglyceride level and glycemic control among insulin-treated patients with type 2 diabetes","volume":"104","author":"Zheng","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.cardfail.2005.04.014","article-title":"Guiding and monitoring of heart failure therapy with NT-ProBNP: Concepts and clinical studies","volume":"11","author":"Richards","year":"2005","journal-title":"J. Card. Fail."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"2811","DOI":"10.1007\/s12325-019-01063-9","article-title":"Algorithm for the use of biochemical markers of bone turnover in the diagnosis, assessment and follow-up of treatment for osteoporosis","volume":"36","author":"Lorentzon","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"e308","DOI":"10.1016\/j.jacl.2024.03.001","article-title":"A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice","volume":"18","author":"Koschinsky","year":"2024","journal-title":"J. Clin. Lipidol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"211","DOI":"10.26444\/aaem\/159702","article-title":"Impact of tick-borne pathogens on the health risk of soldiers","volume":"30","author":"Borecka","year":"2023","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12940-023-00987-8","article-title":"Health consequences of exposure to aircraft contaminated air and fume events: A narrative review and medical protocol for the investigation of exposed aircrew and passengers","volume":"22","author":"Burdon","year":"2023","journal-title":"Environ. Health"},{"key":"ref_88","first-page":"57","article-title":"Evaluation of the impact of oil presence in the aviation fuel on particle size distribution","volume":"94","author":"Pielecha","year":"2017","journal-title":"Sci. J. Silesian Univ. Technol. Ser. Transp."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Phillips, J. (2025). Occupational health considerations of airline pilot radiation exposure. J. Oper. Med.","DOI":"10.62573\/46sb2748"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Soh, M.S., Jang, J.H., Park, J.S., and Shin, J.H. (2024). Effects of high-gravity acceleration forces and anti-gravity maneuver on the cardiac function of fighter pilots. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-59274-2"},{"key":"ref_91","first-page":"370","article-title":"G-induced loss of consciousness: Case-control study of 78 G-Locs in the F-15, F-16, and A-10","volume":"76","author":"Sevilla","year":"2005","journal-title":"Aviat. Space Environ. Med."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/22\/11109\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T05:30:01Z","timestamp":1763530201000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/22\/11109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":91,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["ijms262211109"],"URL":"https:\/\/doi.org\/10.3390\/ijms262211109","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,17]]}}}