Cardiovascular-kidney-metabolic-related domain burden and vascular alterations among adults with type 2 diabetes: a cross-sectional analysis of the Qatar Biobank.

AIMS: To examine vascular alterations across cardiovascular-kidney-metabolic (CKM) domains and characterize sex differences in adults with type 2 diabetes (T2D) from the Qatar Biobank METHODS: Cross-sectional analysis of 5,144 Qatar Biobank adults with T2D. Eight vascular outcomes were assessed: pulse wave velocity (PWV), pulse pressure, carotid intima-media thickness and its variability, resistivity index, and pulsatility index. Three CKM domains were defined: metabolic, cardiovascular, and renal. Hierarchical linear regression and independent-samples t-tests were used. RESULTS: Mean PWV was 15.06 m/s; 87.8% of participants exceeded the pathological arterial stiffness threshold of 10 m/s. Pathological PWV prevalence was higher in females, though males exceeded females at higher percentiles. Structural and Doppler outcomes were higher in females before adjustment but reversed after multivariable adjustment, reflecting confounding by adiposity and comorbidity burden. Age was the strongest predictor across all eight models. Waist-hip ratio, not body mass index, independently predicted PWV, and hypertension was the broadest cardiovascular predictor. Despite the smallest subgroup, the renal domain showed the largest absolute differences in PWV and pulse pressure. CONCLUSIONS: Vascular alterations were prevalent across CKM-related domains in adults with T2D. Findings suggest that sex-specific reference values and domain-stratified vascular assessment may improve cardiovascular risk evaluation in this population.