Cardiovascular-kidney-metabolic-related domain burden and vascular alterations among adults with type 2 diabetes: a cross-sectional analysis of the Qatar Biobank.
Ashour F, Boutemine L, et al. • Diabetes research and clinical practice • 2026
Vascular alterations were prevalent across cardiovascular-kidney-metabolic (CKM)-related domains in adults with type 2 diabetes, with age as the strongest predictor across all vascular outcomes, and the renal domain showing the largest absolute differences in PWV and pulse pressure despite being the smallest subgroup.
Key Findings
Results
The vast majority of adults with type 2 diabetes in the Qatar Biobank exceeded the pathological arterial stiffness threshold for pulse wave velocity.
Mean PWV was 15.06 m/s across the full sample of 5,144 adults with T2D.
87.8% of participants exceeded the pathological arterial stiffness threshold of 10 m/s.
The study used a cross-sectional design drawing from the Qatar Biobank.
Eight vascular outcomes were assessed including PWV, pulse pressure, carotid intima-media thickness and its variability, resistivity index, and pulsatility index.
Results
Pathological PWV prevalence was higher in females, but males exceeded females at higher PWV percentiles.
Sex differences in PWV distribution were non-uniform across the percentile range.
Females showed higher prevalence of pathological PWV overall.
Males surpassed females in PWV at higher percentiles, suggesting a different distributional pattern by sex.
Independent-samples t-tests were used to characterize sex differences.
Results
Structural and Doppler vascular outcomes were higher in females before adjustment but reversed after multivariable adjustment, reflecting confounding by adiposity and comorbidity burden.
Carotid intima-media thickness and Doppler indices (resistivity index and pulsatility index) were initially higher in females in unadjusted comparisons.
After multivariable adjustment, the direction of sex differences reversed.
The reversal was attributed to confounding by adiposity and comorbidity burden.
Hierarchical linear regression was used for multivariable adjustment.
Results
Age was the strongest predictor of vascular outcomes across all eight regression models.
Age independently predicted all eight vascular outcomes assessed.
Hierarchical linear regression models were used to assess predictors.
This finding held across all three CKM domains: metabolic, cardiovascular, and renal.
Age was identified as the strongest predictor across the full sample of 5,144 participants.
Results
Waist-hip ratio, rather than body mass index, independently predicted pulse wave velocity.
Waist-hip ratio was an independent predictor of PWV in multivariable models.
BMI did not independently predict PWV in the adjusted models.
This finding suggests central adiposity distribution, rather than overall adiposity, is the relevant adiposity measure for arterial stiffness in this population.
The metabolic CKM domain was one of three domains examined.
Results
Hypertension was the broadest cardiovascular predictor among CKM-related cardiovascular domain variables.
Hypertension was associated with the widest range of vascular outcomes among cardiovascular domain predictors.
The cardiovascular domain was one of three CKM domains defined in the study.
The three CKM domains assessed were: metabolic, cardiovascular, and renal.
Hierarchical linear regression was used to identify predictors within each domain.
Results
The renal CKM domain showed the largest absolute differences in PWV and pulse pressure despite representing the smallest participant subgroup.
The renal domain subgroup was the smallest of the three CKM domain subgroups.
Despite its smaller size, the renal domain had the largest absolute differences in both PWV and pulse pressure.
This suggests that renal involvement may be associated with disproportionately greater vascular burden in adults with T2D.
Pulse pressure was among the eight vascular outcomes assessed.
Conclusions
The study found that sex-specific reference values and domain-stratified vascular assessment may improve cardiovascular risk evaluation in adults with type 2 diabetes.
Findings were based on a cross-sectional analysis of 5,144 Qatar Biobank adults with T2D.
Sex differences in both crude and adjusted vascular outcomes supported the need for sex-specific reference values.
Domain-stratified assessment across metabolic, cardiovascular, and renal CKM domains revealed distinct patterns of vascular burden.
The authors characterized this as a clinical implication for cardiovascular risk evaluation rather than a directly tested intervention.
What This Means
This research examined how blood vessel damage differs across different disease categories — metabolic (such as obesity and high blood sugar), cardiovascular (such as high blood pressure), and kidney-related — in over 5,000 adults with type 2 diabetes enrolled in the Qatar Biobank. The researchers measured eight different markers of blood vessel health, including how stiff the arteries are (pulse wave velocity), blood pressure characteristics, and ultrasound measures of artery wall thickness. They found that an alarming 87.8% of participants had arterial stiffness above the level considered dangerous for cardiovascular health, with an average stiffness reading well above the threshold of concern.
The study found that age was the single strongest factor linked to worse vascular health across all measures. Interestingly, where fat is carried on the body — specifically a higher waist-to-hip ratio indicating more belly fat — was more important than overall body weight (BMI) in predicting artery stiffness. High blood pressure was the most broadly damaging cardiovascular factor. People with kidney disease, though fewer in number, showed the greatest degree of vascular damage. The study also found notable differences between men and women: women appeared to have more vascular damage on the surface, but when accounting for differences in body fat and disease burden, men actually had worse outcomes on several measures.
This research suggests that assessing vascular risk in people with type 2 diabetes should take into account which disease domains are present — metabolic, heart-related, or kidney-related — because the pattern and severity of blood vessel damage differs across these groups. It also suggests that using the same reference values for men and women when evaluating vascular health may be misleading, and that sex-specific standards could lead to better identification of cardiovascular risk in this population.
Ashour F, Boutemine L, Paco M, Sali M, Gamayon R, Blin K, et al.. (2026). Cardiovascular-kidney-metabolic-related domain burden and vascular alterations among adults with type 2 diabetes: a cross-sectional analysis of the Qatar Biobank.. Diabetes research and clinical practice. https://doi.org/10.1016/j.diabres.2026.113527