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Life sciences · Journal article
Cardiovascular Diabetology · October 29, 2026
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Body mass index (BMI) alone inadequately captures the heterogeneous cardiometabolic risk associated with obesity. In four Chinese cohorts( N = 175,642), BMI–biomarker phenotypic profiles were identified using residual-based clustering of seven routine biomarkers, revealing sex-specific metabolic patterns associated with type 2 diabetes(T2D), chronic kidney disease (CKD) and cardiovascular disease (CVD). The high triglycerides (HTG) profile increased T2D risk and the high blood pressure (HBP) profile increased CVD risk across sexes. Showing distinct sex differences, the high fasting glucose (HFG) profile elevated T2D risk in women (hazard ratio [HR] 2.38[2.03–2.78]) while increasing CVD risk in men (HR 1.12, 95% CI 1.05–1.20). During a median follow-up of 3.8 years, certain phenotype transitions were associated with lower subsequent cardiovascular risk in women, with HFG reversion linked to a 68% lower risk of CVD (HR 0.32, 95% CI 0.11–0.90) and HBP reversion to a 50% lower risk of stroke (HR 0.50, 95% CI 0.30–0.86). These findings provide a phenotype-driven framework for characterizing metabolic heterogeneity and exploring temporal changes in cardiometabolic risk.