Associations of Cardiovascular-Kidney-Metabolic syndrome with premature mortality and life expectancies in US adults: a cohort study
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Background
The American Heart Association recently updated the Cardiovascular-Kidney-Metabolic (CKM) Health advisory, proposing a new framework for defining, staging, and predicting CKM risk. However, the prevalence and adverse effects of CKM stages remain insufficiently characterized.
Methods
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) (1999–2018), including 18,350 US adults aged 20– 79 years. CKM syndrome encompasses subclinical or clinical cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic risk factors. Participants were categorized into four CKM stages based on clinical severity. We assessed associations of CKM stages with mortality risk and life expectancy.
Results
Only 12.9% of participants were classified as CKM stage 0. The prevalence of CKM stages 1, 2, 3, and 4 was 23.1%, 53.6%, 3.6%, and 6.7%, respectively. Compared to CKM stage 0, individuals in stage 4 had a markedly higher risk of all-cause mortality (HR: 4.30, 95% CI: 2.95– 6.26) and lost 15.5 (12.5–19.8) years of life at age 50. Sex and racial/ethnic disparities were also observed.
Conclusions
Higher CKM stages were strongly associated with increased mortality and reduced life expectancy. Our findings underscore the urgent need for enhanced CKM health management, social support, and policy interventions.
Key Messages
What is already known on this topic
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Metabolic disorders, chronic kidney disease, and cardiovascular diseases are significantly associated with premature mortality. By taking into account the overlaps between cardiovascular-kidney-metabolic (CKM) syndrome, it is possible to improve risk stratification and employ an integrated approach to multimorbidity management.
What this study adds?
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Only 12.6% of individuals had no CKM conditions, whereas approximately 50% of individuals had CKM stage 2, encompassing metabolic disorders, chronic kidney disease, or a combination of both.
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The estimated life expectancy of individuals with CKM stage 4 was 15.5 years lower than that of individuals with CKM stage 0 at the age of 50.
How this study might affect research, practice or policy?
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Our results indicate that the CKM condition is prevalent among US adults. We advocate the implementation of the new staging system for the prevention and treatment of CKM syndrome.
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Life expectancy is reduced in adults who have a combination of metabolic risk factors, chronic kidney disease, or cardiovascular disease. We highlight the importance of incorporating a people-centered approach that includes the development of social support and policy, the integration of CKM health multidisciplinary management, and the enhancement of obesity management.
