Aims: Obesity is characterised by pathological alterations in visceral white adipose tissue (vWAT) that may contribute to the development of type 2 diabetes (T2D). While microRNAs (miRNAs) are key post‐transcriptional regulators, comprehensive human vWAT profiling across metabolic states remains limited. This study characterised vWAT miRNA expression in lean, obese and obese+T2D individuals to identify obesity‐driven regulatory networks associated with metabolic dysfunction. Methods: Deep miRNA sequencing was performed on vWAT samples from a discovery cohort comprising lean controls and individuals with obesity (with and without T2D). Findings were validated via RT‐qPCR in an independent replication cohort. Differentially expressed miRNAs were bioinformatically integrated with matched mRNA transcriptomic data to construct putative functional regulatory associations and identify enriched pathways underlying metabolic impairment. Results: The dominant transcriptomic signal was driven by obesity rather than T2D status, with substantial overlap between obese subgroups in principal component analyses. miR‐141‐3p, miR‐200b‐3p, miR‐12 136 and miR‐585‐3p showed consistent differential expression associated with obesity. miR‐141‐3p and miR‐200b‐3p were upregulated and inversely associated with metabolic stress–related genes, including TF and FBXO32. Integrated miRNA–mRNA analyses revealed putative regulatory associations involving inflammation, lipid metabolism, insulin signalling and iron homeostasis. These associations were robust across progressive covariate adjustment models for age and sex. Conclusions: This study provides a comprehensive characterisation of the vWAT miRNA landscape predominantly shaped by obesity, with T2D contributing comparatively subtle additional variation. We identified putative miRNA–mRNA regulatory associations that may contribute to pathological adipose tissue dysfunction. These findings highlight candidate molecular regulators worthy of further functional investigation in the context of obesity and T2D.

Background/Objectives: Cardiovascular disease remains a leading cause of mortality in Spain, with dyslipidemia being a major modifiable risk factor. Lipid-lowering therapy (LLT) is essential for cardiovascular risk reduction, but regional disparities in prescription patterns and LDL-C control persist. This study analyzes LLT prescription trends in Spain in 2019 and 2023, assessing temporal, demographic and regional differences. Methods: A retrospective observational study was conducted using the Spanish Primary Care Clinical Database (BDCAP), which contains 4.8 million anonymized primary care records. LLT prescriptions for primary prevention were analyzed by sex, age, community size, and employment status. Trends from 2019 to 2023 were evaluated, distinguishing between monotherapy and combination therapy. Results: In 2023, 5.8 million individuals received LLT for primary prevention (139.6 per 1000). Women had higher treatment rates than men after age 60. Treatment rates were highest in small communities and among retirees. The use of combination therapies almost doubled from 2019 to 2023, achieving better LDL-C control (56.4% vs. 41.5% with monotherapy, p < 0.001). Regional disparities were evident, with the lowest treatment rates in Cataluña and País Vasco and the highest in Galicia. Conclusion: LLT prescription patterns in Spain show remarkable socioeconomic and regional disparities. The increase in combination therapy suggests a shift towards more intensive lipid management. Standardized guidelines and targeted interventions are needed to ensure equitable and effective dyslipidemia treatment.

Introduction: Achieving LDL cholesterol (LDL-C) targets is critical in secondary cardiovascular prevention. Despite clinical guidelines promoting aggressive lipid-lowering strategies, many patients fail to reach recommended LDL-C levels. This study aimed to evaluate lipid profile management among secondary prevention patients in Spain using the Spanish Primary Care Clinical Database (BDCAP) registry. Methods: A repeated cross-sectional study was conducted using 2019–2023 data from the BDCAP. Patients with prior diagnoses of ischemic heart disease, stroke, or peripheral artery disease, and receiving lipid-lowering therapy, were included. Data on therapy type (monotherapy or combination therapy with lipid-lowering drugs), LDL-C serum levels, and demographic and socioeconomic factors were analyzed. Trends from 2019 to 2023 and regional differences were also explored. Results: In 2023, 1,565,429 patients received lipid-lowering drugs for secondary prevention (678.3 per 1000 attended), with higher rates in men. Combination therapy increased over time, from 88.9 to 191.1 per 1000 between 2019 and 2023. Regional disparities were notable, with treatment coverage ranging from 53.9% to 87.9%. Only 33.7% of treated patients achieved LDL-C < 70 mg/dL, and 65.6% achieved <100 mg/dL. Combination therapy was significantly more effective than monotherapy in reaching both LDL-C thresholds. Conclusions: Despite the growing use of combination lipid-lowering therapy, a substantial proportion of secondary prevention patients in Spain do not meet LDL-C targets. These findings highlight the need for more intensive lipid management strategies and improved adherence to clinical guidelines to optimize cardiovascular risk reduction.

Obesity-driven type 2 diabetes (T2D) is characterized by pathological alterations in visceral white adipose tissue (vWAT). While microRNAs (miRNAs) are key post-transcriptional regulators, comprehensive human vWAT profiling across metabolic states remains limited. This study characterized vWAT miRNA expression in lean, obese, and obese+T2D individuals to identify regulatory networks associated with metabolic failure. Deep miRNA sequencing was performed on vWAT samples from a discovery cohort, followed by validation via qPCR in an independent replication cohort. Differentially expressed miRNAs across the three groups were bioinformatically integrated with matched mRNA transcriptomic data to construct functional regulatory modules and identify enriched pathways underlying metabolic impairment. Several miRNAs exhibited robust and reproducible differential expression between obesity and obesity with T2D. Integrated miRNA–mRNA analyses revealed coherent regulatory modules involving inflammation, lipid metabolism, insulin signaling, and iron homeostasis. Specifically, miR-141-3p, miR-200b-3p, miR-15b-3p, miR-12136, and miR-585-3p showed consistent differential expression. Notably, miR-141-3p and miR-200b-3p were markedly upregulated and inversely associated with metabolic stress–related genes, including TF and FBXO32 . Several miRNAs correlated with clinical markers of metabolic dysfunction, supporting their biomarker potential. By comparing lean, obese, and diabetic populations, this study provides a comprehensive characterization of the vWAT miRNA landscape and identifies specific miRNA–mRNA regulatory circuits that orchestrate the transition from healthy adiposity to pathological adipose tissue dysfunction. These findings pinpoint novel molecular drivers of type 2 diabetes progression and offer potential targets for therapeutic intervention in metabolic endocrine disorders.