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Article History

Received: 26 August 2025

Revised: 9 April 2026

Accepted: 21 April 2026

First Online: 9 May 2026

Competing interests

: WR reports the receipt of honoraria for educational sessions run by NovoNordisk outside of the topic of the current analyses. TZ is funded by the German Research Foundation, the EU Horizon 2020 program, the EU ERANet and ERAPreMed Programs, the German Center for Cardiovascular Research (DZHK, 81Z0710102) and the German Ministry of Education and Research. TZ is listed as co-inventor of an international patent on the use of a computing device to estimate the probability of myocardial infarction (International Publication Number WO2022043229A1). TZ is a shareholder of the ART.EMIS GmbH Hamburg. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

: The KORA studies were performed in accordance with the Declaration of Helsinki 1964. Written informed consent was obtained from all participants at baseline and at each data collection examination. Study methods were approved by the Ethics Committee of the Bavarian Chamber of Physicians for each study since 1998 (KORA S4: EC No. 99186, F4 study and FF4 study: EC No. 06068). Prior to that, all studies were approved by the local authorities and conducted in accordance with the data protection regulations valid at the time. The KORA S3 study was prior to 1998 and therefore the last sentence above applies.