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Article History

Received: 20 October 2025

Accepted: 13 January 2026

First Online: 9 February 2026

Declarations

:

: Data from the ARIC study are publicly available through request from the Biologic Specimen and Data Repository Information Coordinating Center of the National Institutes of Health: . Data from the MESA study are publicly available through request from the Biologic Specimen and Data Repository Information Coordinating Center of the National Institutes of Health: . The Look AHEAD data used for analysis during the current study were housed at the data coordinating center and are not available for public distribution. However, all data used for this analysis were supplied by Look AHEAD investigators to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository and are publicly available at .

: M.P.B. is the guarantor of this work. As such, he takes responsibility for the integrity of the data and the accuracy of the data analysis and affirms that the manuscript is an honest, accurate, and transparent account of the study being reported. All authors made substantial intellectual contributions, participating in creating and designing the study, analyzing and interpreting the data, and reviewing this manuscript. C.M.G. contributed to the methodology, drafting of the manuscript, and revisions of the manuscript. A.M.A. led the statistical analysis and contributed to revisions of the manuscript. C.J.P. contributed to the methodology and revisions of the manuscript. D.M.R. contributed to the methodology and revisions of the manuscript. P.L.L. contributed to the methodology and revisions of the manuscript. L.E.W. contributed to the methodology and revisions of the manuscript. M.P.B. led the study design, drafting of the manuscript, and overall supervision. All authors have read and approved the final report for publication.

: The authors have no conflicts to disclose. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Eye Institute; the National Institutes of Health; or the US Department of Health and Human Services. The National Institutes of Health did not have a role in design, methods, subject recruitment, data collections, analysis and preparation of this paper.

: This analysis was reviewed and approved as exempt by the Institutional Review Board (IRB) of Wake Forest University School of Medicine (IRB00092117, approved 05 January 2023). This study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

: For each of the parent studies, participants provided informed consent, and local institutional review boards approved the study protocol for each exam.

: Not applicable.

: Statistical code is available upon request.